It is a truth universally acknowledged that the restoration of anatomy does not consistently result in physiological improvement. Whilst not unique to pelvic surgery, procedures therein suffer a higher misfortune of unintended functional sequelae. Increasingly, we have come to recognise that our role does not end at anatomical restoration. To optimise a patient’s quality of life, we need to understand how to address postoperative dysfunction and identify the underlying factors that drive it.