Background: Although studies suggest that optimism can predict health outcomes, the relationship has not been tested in women with pelvic organ prolapse (POP). This study sought to explore the relationship between optimism, prolapse severity, and symptoms before operation; and examine whether optimism predicts postsurgical functional status, treatment satisfaction, and treatment success. Study Design: Data from the randomized Colpopexy and Urinary Reduction Efforts (CARE) study, in which stress continent women undergoing sacrocolpopexy to repair stage II to IV POP completed a baseline assessment of optimism and validated symptom and quality-of-life measures at baseline and 24 months. Relationships between optimism and demographics, clinical status, and functional and quality-of-life outcomes were assessed. Results: Of 322 Colpopexy and Urinary Reduction Efforts study participants, 305 (94.7%) completed 24-month followup interviews. At baseline, there were no notable differences in optimism with respect to POP stage or history of earlier operations for prolapse or urinary incontinence. At baseline, women with greater optimism reported markedly better physical and mental functioning (p ≤ 0.001) and less symptom distress (p ≤ 0.01). Two years after operation, the difference in symptom experience across the three optimism categories narrowed; all women reported improved health status, fewer symptoms, and less impact on daily activities. Satisfaction with treatment and perception of treatment success were not associated with optimism. Conclusions: In women planning operation for POP, optimism is related to pelvic symptom severity, but is not associated with satisfaction with treatment or treatment success. Abdominal sacrocolpopexy resulted in substantial improvements in quality of life and functional outcomes that were not notably influenced by optimism. © 2008 American College of Surgeons.