Perineal scar endometriosis is a devastating illness with grave consequences. An early diagnosis is imperative as a delayed diagnosis results in extension of the disease process causing increasing damage to adjoining structures like the anal sphincter and rectum. A late recognition of the disease also prolongs the agony of the patient owing to its being a very painful condition. Two cases are presented of parous women in their early thirties who had episiotomy scars preceding the development of endometriosis. The cases were treated by a perineal incision and removal of suspicious structures. However, a recurrent endometrioma was formed in one case, which had to be excised again. In the other case, symptoms of recurrence had begun, which subsided after a dose of GnRh analogue (leuprolide acetate 3.75 mg). Both patients are on follow-up and are fine until now.