Objectives To establish anatomical structures responsible for a resistance force on a fetal head during vaginal delivery; assess the postpartum perception of perineal pain and superficial dyspareunia; develop a new episiotomy. Design A prospective observational case series study. Setting International sites. Population Eighteen pregnant women in labor Methods Small V-shape excision was made on the posterior-lateral vaginal outlet without incising the posterior perineum or vaginal wall. Simple interrupted sutures were used to repair the surgical defect (outlectorrhaphy). Histological examinations were performed on excised specimens. Main Outcome Measures The primary maternal outcome measured postpartum perineal pain; the secondary outcome measured occurrences of superficial dyspareunia, results of Ostrzenski’s vaginal outlectomy, and APGAR scores measured the neonatal outcome. Results The small V-shape excision widened the vaginal outlet sufficiently for a vaginal delivery. Outlectorrhaphy required two-three simple interrupted sutures. All subjects were delivered vaginally with median newborns’ weight of 3,550 gm ±250gm and median APGAR scores of 9 ±1 at 5 minutes. One patient experienced a grate II extension tear with bleeding heavier than an uncomplicated vaginal outlectomy. Postpartum patients reported no moderate or severe perineal pain and no superficial dyspareunia. Histology showed that the vaginal outlet was deferred from the vaginal walls. Conclusions The vaginal outlet is responsible for resistance force on a fetal head. No moderate or severe perineal pain or dyspareunia occurred in this study group. Ostrzenski’s vaginal outlectomy widens the vaginal outlet sufficiently for a fetal vaginal birth, and it is easy to repair.