We read with great enthusiasm the article published by Lowder et al regarding the construction of a body image questionnaire for women with pelvic organ prolapse (POP). We think the authors have solved a problem when exploring body image in POP studies because this variable has not been explored adequately. In our opinion, body image is the most important variable that should be questioned after surgery; after all, POP surgery is a plastic reconstructive modality that influences many immediate and late outcomes and is influenced by gynecologic and socioeconomic characteristics.

We would like to point out one limitation of the study that the authors addressed. While POP is more frequent in white women, the body image in the POP questionnaire did not explore other cultural scenarios and racial differences. An observational study in Brazil with young women from an indigenous tribe found a high prevalence of POP stage ≥2, with few of them complaining of POP symptoms. Certainly, as the authors have reflected, cultural and religious background are extremely important for the construction of body image; therefore, we also believe this questionnaire should be explored in different countries, religions, and cultural settings to strengthen its validity. Once more, we congratulate the authors for creating an important questionnaire to explore this personal side of women who have this increasingly common condition.