Contemporary fast magnetic resonance imaging techniques allow dynamic evaluation of the entire female pelvic floor with excellent visualization of pelvic organs and muscular and fascial supportive structures in a single noninvasive study that does not expose the patient to ionizing radiation. This article focuses on the role of magnetic resonance imaging in defining pelvic floor defects that can guide surgical management of women with pelvic organ prolapse, especially those who undergo evaluation for symptoms of multicompartmental involvement before a complex pelvic floor reconstruction or those who have failed previous repairs.