Objective. Surgical repair of perineal lesions after delivery is frequently associated with pain and discomfort, interfering with the normal activities of the puerperium. The aim of this study was to compare perineal skin repair after episiotomy with adhesive glue versus a subcuticular suture, regarding the incidence of pain and wound complications. Study design. Randomized clinical trial. Setting. Tertiary care university hospital. Material and methods. One hundred women having mediolateral episiotomy at vaginal delivery were enrolled. They were randomized to receive skin adhesive (n = 53) or subcuticular suture (n = 47) for closure of perineal skin. The main outcome measure was self-evaluated pain in the 30 days following delivery. Secondary outcome measures were technical difficulties reported with the procedure, duration of surgical repair, wound complications observed at 42–68 hours post-partum and re-initiation of sexual activity by 30 days post-partum. Results. No significant differences were observed between the two groups in incidence of technical difficulties and failed procedures, pain during the procedure, wound complications at hospital discharge, self-evaluated measures of pain at 7 and 30 days or re-initiation of sexual activity by 30 days post-partum. The skin adhesive group had a significantly shorter mean duration of the procedure (four minutes less). Conclusion. Perineal skin closure using adhesive glue is faster than subcuticular suture, and associated with a similar incidence of complications and pain in the first 30 days.