Title: Sexual dysfunction in women with genital warts: a cross sectional study
Version: 2 Date: 10 Mar 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This study effectively examines the impact of genital warts on
female sexual dysfunction and quality of life, highlighting significant associations with age,
disease duration, and psychological distress. The findings align with previous literature,
reinforcing the negative psychosocial and psychosexual effects of genital warts. However,
inconsistencies with some studies suggest the need for further exploration of demographic
and cultural influences. The study's methodology is clear, but the lack of a control group and
a relatively small sample size limit the generalizability of results. Selection bias may have
influenced findings, as participants were recruited from a single institution. The discussion is
well-structured, but some sentences are overly complex and require revision for clarity. The
study acknowledges the sensitive nature of sexual health research, though reporting bias could
have affected responses. More emphasis on potential clinical implications and recommendations
for intervention strategies would strengthen the conclusion. Future research should include
larger, more diverse populations to validate these findings. Despite its limitations, the study
provides valuable insights into the burden of genital warts on women's sexual and emotional
well-being.
REQUESTED REVISIONS:
I recommend to take into account the following suggestions:
- Introduction: The first sentence presents the prevalence of genital warts but lacks a reference
to regional variations, which could provide a more comprehensive epidemiological context.
Including geographical variations in prevalence would strengthen the introduction.
- Introduction: The second sentence lists multiple factors influencing genital wart contraction
but does not specify how each factor contributes, making the statement overly broad. Clarifying
how each factor specifically affects incidence would improve clarity.
- Introduction: The psychological impact of genital warts is mentioned, but there is no mention of
long-term consequences or coping mechanisms, which could provide a more complete picture.
Expanding on the long-term psychological burden would enhance the discussion.
- Introduction: The section on female sexual dysfunction (FSD) introduces different
dysfunctions but does not connect them directly to genital warts until later, which affects
coherence. Reordering the sentence to establish a clearer link between genital warts and FSD
from the beginning would improve readability.
- Introduction: The estimated prevalence of FSD is stated as 40%, but the reference is missing,
making it unclear if this figure is specific to women with genital warts or the general population.
Clarifying whether this statistic applies to all women or only those with genital warts would
increase accuracy.
- Introduction: The discussion on sexual dysfunction in women with genital warts is somewhat
fragmented, with different factors affecting sexual health listed separately rather than in a
structured manner. Organizing the factors into psychological, relational, and physical categories
would enhance readability.
- Introduction: The phrase "concerns about the spread of lesions or recurrence of lesions" is
somewhat redundant and could be streamlined for conciseness. Rewriting it as "concerns about
lesion recurrence and transmission" would improve clarity.
- Introduction: The introduction states that genital warts threaten sexual health but does not
elaborate on the physiological mechanisms beyond psychological and relational impacts. Briefly
discussing physical symptoms such as pain or discomfort during intercourse would add depth.
- Introduction: The sentence "lack of sufficient sexual knowledge and skills" is vague and
may not be universally applicable, as knowledge levels vary. Specifying whether this refers to
misconceptions about HPV or general sexual education would improve precision.
- Methods: The phrase "The whole cross sectional study" is awkwardly worded and could be
more precise. Rewriting it as "This cross-sectional study" would improve clarity and readability.
- Methods: The sentence "Confidentiality and personal privacy were respected in all levels of
the study and Collected data were not be used for any other purposes" contains grammatical
errors. Correcting it to "Confidentiality and personal privacy were maintained at all stages of
the study, and collected data were not used for any other purposes" would be more correct.
- Methods: The eligibility criteria mention "100 Females," but it is unclear whether this was a
predefined sample size or the number of participants meeting the criteria. Clarifying whether
100 was the target or final enrolled sample would improve transparency.
- Methods: The exclusion criteria include "those with history of mastectomy, oopherectomy,"
but it is unclear why these conditions would impact the study. Providing justification for these
exclusions would strengthen the methodological rationale.
- Methods: The sentence "and taking psychotropic drugs except for benzodiazepines" is unclear
because it does not specify why benzodiazepines were an exception. Explaining this decision
would provide better methodological transparency.
- Methods: The phrase "privacy and confidentiality were assured" in the FSFI section is
redundant since confidentiality was already mentioned. Removing or integrating it more
naturally would improve flow.
- Methods: The FSFI questionnaire description is overly detailed in listing the item numbers for
each domain, which may not be necessary in the methods section. Summarizing the domains
assessed without listing each question number would improve readability.
- Methods: The statistical analysis section lacks a clear description of the specific tests applied
to compare groups. Adding details on which tests were used for different types of data would
enhance methodological rigor.
- Methods: The sample size calculation states "a sample size of 100 was determined to be
statistically significant," but significance applies to results, not sample sizes. Rewriting it as
"a sample size of 100 was determined to be adequate for statistical analysis" would be more
accurate.
- Methods: The phrase "All participants underwent the following:" at the end is incomplete and
does not introduce any further content. Removing it or ensuring it leads into the next section
would improve coherence.
- Results: The phrase "rural city side" is unclear and inconsistent; it should be revised to “rural
areas" for better readability.
- Results: The sentence "32% of participating women had a job and only 12% were
knowledgeable about HPV" lacks parallel structure. Rewriting as "While 32% of participating
women were employed, only 12% had knowledge about HPV" would improve flow.
- Results: The section describing FSFI scores lacks context about what a low or high score means
for sexual function. Briefly explaining the FSFI scoring system would make the results more
interpretable.
- Results: The phrase "significant very large impact" is awkwardly worded. Rewriting as "a
significantly large impact" would improve clarity.
- Results: The term "sport performance" seems out of place in the context of quality of life and
sexual dysfunction. Clarifying why it is relevant or removing it would improve coherence.
- Results: The phrase "Factors associated with FSD demonstrated that there existed a significant
direct correlations" is overly complex. Rewriting as "Factors associated with FSD showed
significant direct correlations" would make it more concise and readable.
- Results: The sentence "while QOL was significantly higher among those living in urban areas
and among working individuals in the study group (p < 0.001; p=0.007; respectively)" lacks
clarity. It would be clearer as "Quality of life was significantly higher among participants living
in urban areas (p < 0.001) and those who were employed (p = 0.007)."
- Discussion: "In current study" is grammatically incorrect and should be revised to "In the
current study" for proper structure.
- Discussion: The sentence "Among the majority of studies investigating demographic and social
characteristics of women infected with GWs, duration of marriage, age of subject, level of
education as well as site of residence and knowledge of HPV were among the most factors
to affect sexual function" is overly complex and unclear. It should be rewritten for clarity,
such as "Most studies investigating demographic and social factors in women with GWs have
identified duration of marriage, age, education level, residence, and HPV knowledge as key
factors affecting sexual function."
- Discussion: "Results among different studies remain to be contradictory" is awkwardly
phrased. Rewriting it as "Findings from different studies remain contradictory" would improve
readability.
- Discussion: The sentence "These complaints were inversely related to the level of education
and income of women" lacks specificity. It should clarify which complaints are being discussed,
e.g., "Sexual dysfunction complaints were inversely related to women's level of education and
income."
- Discussion: "A 68% and 42% reduction in libido and frequency of sexual intercourse were
reported in one study among which 19% of included subjects reported rejection by their partner
and 71% were unable to engage a new relationship" is difficult to read. It should be rewritten
as "One study reported a 68% reduction in libido and a 42% decrease in sexual intercourse
frequency, with 19% of participants experiencing partner rejection and 71% unable to enter a
new relationship."
- Discussion: "In contrary to such results" is incorrect; "In contrast to these findings" would be
more appropriate.
- Discussion: "refugees)and the less significance of GWs for them" has a grammatical issue. It
should be rewritten as "refugees) and the lower perceived significance of GWs for them."
- Discussion: "Almost all female subjects reported significant negative affection of their life" is
unclear and should be revised to "Almost all female participants reported a significant negative
impact on their quality of life."
- Discussion: The phrase "The major limitation of our research was the absence of a control
group, relatively small sample size as well as confinement of patient selection to one institute
which could attribute to selection bias" needs better flow. It should be rewritten as "The major
limitations of this study include the absence of a control group, a relatively small sample size,
and the selection of patients from a single institution, which may contribute to selection bias."
- Discussion: "Further research is advised on diverse population" is incorrect; it should be revised
to "Further research is recommended in diverse populations" for grammatical accuracy.