Review for 10.1186/1471-230X-8-45 (2008)

Reviewer's report
Title:Determinants of female sexual function in inflammatory bowel disease. A
survey based cross-sectional analysis
Version: 1Date:7 March 2008
Reviewer: Robert Maunder
Reviewer's report:
This paper addresses a clinically important and understudied problem. Given the
limited previous research, a cross-sectional survey with self-report measures is a
sensible methodology by which to gather the information required for the
formation and testing of hypotheses in the future.
There are several problems with the manuscript in its current form. The pages
are not numbered so I will identify comments by the section in which they occur.
Major Compulsory Revisions
Methods
Patients with co-morbid illnesses were excluded “if interference with quality of life
was considered likely” – by what criteria? A list of excluded conditions would be
helpful.
The Clinical Index Activity “was previously validated (manuscript submitted).”
Until there is another source to cite regarding the validity of the instrument, some
more detail is required about the properties which suggest that this is a valid
measure.
Similarly for the German version of the BISF-W, some details about its validity
are required in the absence of another source to cite.
Discussion
That there is low frequency of intercourse in women with active disease is not
surprising. I found the more striking finding to be that this low prevalence is also
true for women in remission. Did this (and the other measures of sexual function)
vary with age?
In general the discussion is hard to understand in several places because of
awkward English. For example one paragraph begins “It is unclear why this effect
was different in the different case groups, and why it was not amenable to control
for potential confounders of relationship appreciation.” I don’t know what this
means. Similarly, the first sentence of the last paragraph is difficult to
understand.
Loss of desire may result from pain, fatigue or distress it is noted. Loss of desire
may also result from inflammation and the systemic effects of inflammatory
cytokines.
Can the authors suggest any mechanism by which smoking might be related to
vaginal dryness?
Minor Essential Revisions
It is not clear in the abstract, as it is in the methods, that the z-scores are
(appropriately) zeroed on the normative sample mean.
A list of acronyms for measurement instruments is presented at the bottom of the
first page of the methods “S-IBDQ, EORTC” etc. These should be explained.
In the results section, the response rate in the outpatient sample is not given.
BISF-W scores are limited to women with partners. The number and proportion
of women who this applies to should be given in the text – it is awkward to have
to refer to Table 1 to find it.
The numbers of patients with active disease/in remission should be noted on
Figure 2.
Discretionary Revisions
Responder bias is suggested a reason why the DCCV sample differs from the
clinical sample with respect to partner satisfaction– based on the possibility that
women with unsatisfactory relationships in the DCCV might be more likely to
respond for some reason. No reason is provided why this would be likely to be
the case and I can’t think of any. Might it be that women with unsatisfactory
relationships at home are more likely to join a support group? In that case the
study sample might be representative of DCCV members in spite of lower
response rate but the two DCCV and clinical might truly differ.
What next?: Unable to decide on acceptance or rejection until the authors have
responded to the major compulsory revisions
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests