Objective To explore the diagnostic value of transperineal two-dimensional combined with three -and four-dimensional ultrasonography in female pelvic floor dysfunction (FPFD), and analyze its advantages in anatomical evaluation and functional monitoring. Methods Sixty patients diagnosed with FPFD who visited Ma’anshan People’s Hospital from October 2022 to November 2024 were selected as the experimental group (FPFD group, n=60). In addition, 60 patients with normal pelvic floor function who visited the hospital during the same period were selected as the control group (non-FPFD group, n=60). Both groups of patients underwent transperineal two-dimensional ultrasound and two dimensional combined with three-and four-dimensional ultrasound, and the pelvic floor fissure area and functional dynamic indicators (bladder neck mobility and urethral rotation angle) were recorded. Then, compare the diagnostic accuracy of the two groups. Results The pelvic floor fissure area of the experimental group patients during rest, anal sphincter contraction, and Valsalva maneuver was significantly larger than that of the control group (P<0.05). Dynamic function assessment showed that bladder neck mobility and urethral rotation angle were significantly higher in the experimental group than those in the control group (P<0.05). The overall diagnostic accuracy rate of two-dimensional combined with three-dimensional and four-dimensional ultrasound (91.67%) was significantly higher than that of twodimensional ultrasound alone (70.00%, P<0.05). Conclusion Transperineal two-dimensional ultrasound combined with three - and four-dimensional ultrasonography has significant advantages in the anatomical evaluation and functional monitoring of FPFD, which can significantly improve diagnostic accuracy and provide important basis for the precise diagnosis and clinical management of FPFD.