Abrasive water jet (AWJ) perforation is an effective mean for stimulation in oil and gas wells. However, the mechanism of perforation formation and the regulation of its parameter remain poorly understood. This study investigates the variation in hole shape during AWJ perforation through a series of experimental designs and analyses. By analyzing the variation in perforation shape with injection time, the rock-breaking damage caused by AWJ and the flow characteristics in the perforation were quantitatively characterized. The results show that the process of perforation formation is governed by the coupling of three physical effects. The inflow increases the hole depth by vertically impacting the hole tip, while the backflow enlarges the hole diameter by eroding the hole wall. As the fluid mechanical energy dissipates along the path, the evolution of the perforation slows down during the later perforation period. Because the rock breaking ability of inflow is stronger than that of backflow, the ratio of hole depth to hole diameter of AWJ perforation increases with the increase of injection time. Specifically, when the injection time ranges from 5 s to 300 s, the ratio increases from 7 to 28. The rock breaking ability of the backflow decreases from the tip to the orifice, whereas the duration of the backflow’s action on the hole wall increases in the same direction. Under the combined influence of rock breaking ability and rock breaking time, the hole evolves from a conical shape to a spindle shape, and the degree of spindle increases. With the increase of injection time and hole depth, the fluid mechanical energy loss becomes more severe. The change rate of hole depth decreased to 11.3% and the change rate of hole diameter decreased to 4.3%. The evolution of the AWJ perforation became slow.