This document discusses perineal issues related to childbirth. It notes that 65% of women experience some degree of perineal trauma during delivery, which can cause pain, infection, wound breakdown, and dyspareunia. Tears are classified from first degree (skin tear) to third degree (involving the anal sphincter). Reasons for more severe third and fourth degree tears include large baby size, forceps delivery, and prolonged second stage of labor. Episiotomies are sometimes performed to expedite delivery or prevent severe trauma, but midline incisions can increase the risk of anal sphincter damage. Perineal massage during pregnancy may slightly increase the chances of an intact perineum