This chapter discusses the perineal repair. The technique of perineal repair is based on three basic surgical principles: Identification of the structures involved—most importantly the vaginal mucosa, perineal muscles, external and internal anal sphincter, rectal mucosa, and anal epithelium, assurance that a dead space is not left following the repair to minimize the risk of hematoma formation and infection, and careful apposition of the anatomical layers to ensure the best chance of healing and minimize long-term symptoms. Episiotomy repair, repair of midline episiotomy, posterolateral episiotomy, mediolateral episiotomy, and second-degree perineal tears are some other important topics, which are also covered in this chapter. 27 well-colored clinical images are also presented in this chapter.