The pathophysiology of pelvic organ prolapse is believed to be multifactorial. Several risk factors, such as childbirth and aging, have been identified. Suspected aberrations in the structure and function of the connective tissue, muscles, and nerves of the pelvic floor are still under investigation. In this article, the cellular, biochemical, and molecular basis of pelvic organ prolapse is discussed with a focus on the new theory of elastinopathy as an etiology of prolapse.