Episiotomy is a widely used surgical procedure, introduced in the medical practice with no support of its benefit from scientific evidence. It is still used routinely despite not accomplishing the major goals for which it was pretended. In fact, it does not decrease the risk of severe perineal lacerations, it fails to prevent the development of pelvic relaxation and it does not have any impact in newborn mortality or morbidity. Many trials, retrospective and prospective, have compared general versus selective use of episiotomy. A selective use is associated with better results, such as a decrease of severe lacerations, a highest number of women in whom the perineum remains intact, despite an increase in anterior lacerations. It seems correct to recommend a selective episiotomy, and many authors suggest the use of this procedure in 30% of the cases. It is now very important to improve new birthing techniques that maintain the integrity of the perineum and do not involve surgical procedures. More trials are necessary to clarify which are the real indications to use episiotomy. Meanwhile, without the proper scientific evidence, the most correct attitude seems to be a careful use of episiotomy, with decisions on a case-by-case basis.