Vaginal trauma also occurs during an episiotomy and vaginal childbirth. Selective use of episiotomy results in less perineal trauma. Perineal pain after episiotomy has immediate and long-term negative effects for women and their babies. Vaginal trauma occurs during an episiotomy. Specific causes are manifold and include obstructed labor, hysterectomy, malignancy, radiation, episiotomy, and bowel disorders. Some midwives compare routine episiotomy to female genital mutilation. Some childbirth facilities have a policy of routine episiotomy. Risk factors include a history of sexual assault, endometriosis, vaginitis, or a prior episiotomy. Whether episiotomy reduces, or indeed increases, the chances of faecal incontinence is difficult to say. Having an episiotomy is associated with stenosis. A scar from an episiotomy was also found on her body. The authors were unable to find quality studies that compared mediolateral versus midline episiotomy. Risk factors include prolonged labour, difficult instrumental delivery and paramedian episiotomy. GPs and ONs are associated with higher use of episiotomy and oxytocin. An episiotomy may be performed if necessary.