Perineal tears are one of the most common complications of vaginal births and may cause discomfort and pain long time after childbirth. Visual and digital examination of perineal tears is the most common way to assess and classify a perineal tear. Recent research indicates that many tears diagnosed are misclassified. The aim of this systematic literature review was to outline research that investigates healthcare professionals’ clinical knowledge in assessment and classification of perineal tears in connection with childbirth. Searches were performed in PubMed and CINAHL. Six studies on the topic were identified and  used to collect data for questionnaires. An integrative review was used in the analysis. Poor knowledge in perineal anatomy and lack of training in clinical assessment and classification of perineal trauma was evident among both physicians and midwives. These findings indicate that healthcare providers lack adequate knowledge and that they make incorrect assessments and errors in classification of perineal tears. The training in assessment and classification is crucial. Midwives are in a unique position to improve the standard of care in this field since they are often the first and many times the only to assess the injury.