This chapter describes instrumentation and techniques for pelvic floor ultrasound with introital and perineal approaches. The reader will learn about the specific equipment, image orientation, optimization, and details of 2D and 3D/4D imaging techniques. The chapter also describes different applications of introital and perineal imaging for the evaluation of pelvic floor dysfunction, including pelvic floor biometry, pelvic floor hiatus and pelvic floor muscles evaluation, anal and urinary incontinence, and pelvic organ prolapse.