The perineum can be a challenging area for reconstructive surgeons due to the presence of structures integral to micturition, defecation, and sexual function. The goal of this chapter is to provide a basic understanding of perineal anatomy, types of injuries/illnesses requiring reconstruction, as well as a brief algorithm for various options for reconstruction. The scope of this chapter will neither include gender affirmation surgery nor pressure wound reconstruction, as those topics will be covered in more extensive detail in separate chapters.