Each year, pelvic floor dysfunction affects between 300,000 and 400,000 American women so severely that they require surgery. Approximately 30% of the operations performed are re-operations. The high prevalence of this problem indicates the need for preventive strategies, and the common occurrence of re-operation indicates the need for treatment improvement. Efforts at prevention and treatment improvement will only be possible if research clarifies causative mechanisms and scientifically valid studies discover why operations fail. By reaching a goal of 25% prevention we could save 90,000 women from experiencing pelvic floor dysfunction and with 25% treatment improvement we could avoid 30,000 women from needing a second operation. To achieve these goals we must discover specific events or behaviors in a woman's life that lead to these problems and that are amenable to preventive strategies. In addition, we must define specific biologic and behavioral factors that explain why certain women have recurrence after surgery. Because the pelvic organ support system is comprised of muscles, ligaments, and nerves arranged in a complex tension-based apparatus, the basic nature of this work must include biomechanical analyses of the overall mechanism and targeted research into the biology of muscle, ligament, nerve, and their complex interactions in normal pelvic floor function and in symptomatic patient. Each of these scientific disciplines is well developed so that engaging scientists in the effort to move forward will bring predictably important results. With an integrated approach to this problem over the next 20 years, it should be possible to achieve these goals and reduce the suffering for more than 100,000 afflicted women.