A 4-year-old female Holstein was presented for repair of a third-degree perineal laceration sustained during its second parturition. A 10 cm deep third-degree perineal laceration was diagnosed on physical exam. Multiple tissue bands bridged the perineal region caudally as a result of three previous failed repair attempts. Surgical repair was performed using a modified Aanes technique. Follow-up telephone interviews with the owner revealed that the repair remained intact, but after three breedings the cow had yet to become pregnant. The integrity of the perineal body, perineal septum and external anal sphincter plays a crucial role in preventing contamination of the reproductive tract. Cows with third-degree perineal lacerations have an increased risk of endometritis and reduced fertility. Repair of third-degree perineal lacerations using a modified Aanes technique is an effective surgical treatment to restore proper anatomy and prevent further reproductive tract contamination however return to reproductive function is dependent upon additional factors.