Purpose:First, to determine the ability of MRI to visualize normal and abnormal elements of the pelvic supporting system, especially the urethral support. Second, can correlation between the static & dynamic MR images help to understand normal & abnormal pelvic floor function- structure relationship?. To determine the role of MRI, in pre and post operative evaluation of females with pelvic floor dysfunction (PFD).Materials and Methods:This study included 55 females, 17 controls, & 38 females with pelvic floor dysfunction (PFD) the later group was further divided according to their main clinical complain into: 2A: Stress urinary incontinence (SUI), 2B: SUI+ Genital Prolapse (GP), 2C: Genital Prolapse , 2D: Fecal Incontinence+/- other complaints.Evaluation of patients included history, physical examination, Cystourethrography (CUG), Defecography, MRI static and dynamic. Additionally 12 patients were reevaluated after treatment to compare pre and post operative findings.Criteria for evaluation in static MRI included the type & level of fascial or urethral supporting system defects. Urethral ligaments were dissected in six cadavers, labeled by a marker for identification on MRI done to those cadavers. The MR images of the cadavers were compared to those of the control group. In the dynamic : H line, M line, Levator plate Angle (LPA) ,Iliococcygeus angle (ILC A), Width of the levator hiatus (W L H) , Bladder neck descent (BNDs) as well as the presence of pelvic organ prolapse were evaluated .Results:The Normal pelvic supporting elements were all clearly visualized. Guided by the marker placed on the different urethral supporting ligaments in the cadavers, we identified different orientation of two of the urethral supporting ligaments (the pubourethral and uretheropelvic ligaments) in the static axial MR images from that described in other studies. To our knowledge those orientations haven’t been described previously.There was highly statistically significant difference between the control group and the other 4 groups regarding the H line, M line, LPA, ILC A and the W L H (p< 0.001) in the dynamic MRI sequences. There were good correlation between the static and dynamic MRI findings, and the MRI classified the predominant defective element in nearly all patients. Pre operatively MRI added significant information that changed the management of most of our cases, postoperatively MRI can evaluate success of surgical procedure and identify complication.Comparing dynamic MRI to CUG (as the golden standard) the sensitivity, specificity +ve & - ve predictive value of dynamic MRI to detect the presence of bladder neck or base descent was 95.5%;100%; 100% & 76%, and 94.1%; 42.9%; 80% & 75% respectively. Comparing the MRI to physical examination, we found that the most frequent pathology to be missed by MRI was rectocele (if the rectum was not opacified). However, MRI was obviously superior in detecting peritoneocele and sigmoidocele compared to clinical examination.Conclusion:Dynamic and static MRI, can evaluate pelvic supporting elements and diagnose anatomic causes of dysfunction. The correlation between the static and dynamic examination, has offered a new insight in PFD (a concept that to our knowledge have not been studied in previous literature). In addition MRI has a unique ability to assess the patients post operatively, explain success or failure of the procedure & detect complication.