Female pelvic floor dysfunction encompasses a number of prevalent conditions and includes pelvic organ prolapse, urinary and fecal incontinence, obstructed defecation and sexual dysfunction. In most cases neither etiology nor pathophysiology are well understood. Imaging has great potential to enhance both research and clinical management capabilities, and to date this potential is under-utilised. The most common indication for pelvic floor imaging is female pelvic organ prolapse. Translabial realtime ultrasound during a Valsalva maneuver will demonstrate cystocele, uterine prolapse, rectocele, enterocele and rectal intussusception and allow quantification against the inferoposterior symphyseal margin. The introduction of 3D/4D imaging has allowed us to diagnose major pelvic floor trauma (ëavulsioní) and overdistension of the levator hiatus (ëballooningí) reliably and accurately. Most recently, translabial 4D imaging of the anal sphincter has made the assessment of anal incontinence simpler and less invasive. This technique will allow universal audits of of OASIS repair and eventually of obstetric management in general, enabling the introduction of ëmaternal birth traumaí as a key performance indicator of obstetric services.