We appreciate the interest in our article expressed by Drs Brito, Arouca, and Norueira. They highlight an important consideration in measure development. Validation of a measure in diverse populations with a wide range of ethnic, social, and religious backgrounds is ideal because it improves the validity and generalizability of the measure. Although there are likely universal prolapse-related body image themes in women, we agree that language and cultural, social, and religious differences will likely impact how women interpret, experience, and express prolapse-related body image. We truly hope that other researchers will use this measure and translate and validate it in other cultural groups. We look forward to working with other investigators to enhance the generalizability and usefulness of the body image in pelvic organ prolapse questionnaire.