Reviewer’s report
Title: 
Socio-demographic Determinants of Low Sexual Desire and Hypoactive
Sexual Desire Disorder: A Population-based Study in Iran
Version: 
1 
Date: 
11 May 2020
Reviewer's report:
Socio-demographic Determinants of Low Sexual Desire and Hypoactive Sexual
Desire Disorder: A Population-based Study in Iran
Overall comments: This is an interesting study on low sexual desire (LSD) and
hypoactive sexual desire disorder (HSDD). First, clinically, is there a distinctive
difference between LSD and HSDD for women suffering from lack of sexual
desire? This issue should be resolved in the discussion, addressing the validity of
the former clinical entity. Along the way in the manuscript, the author mentioned
that LSD is a diagnosis (line 29 and 39, p. 8). Is LSD a diagnostic criterion? I
believed this can be resolved with in-depth discussion under the Discussion
section, in your limitation(s) segment.
On another note, the discussion of HSDD is incomplete without looking on other
domain of female sexual functioning, i.e. sexual arousal, orgasm, sexual
satisfaction and even sexual pain. As we know, the sexual response cycle is a
concept of psychophysiological changes, and they were interactive with each
other's phases. Many factors play a role in this paradigm of conceptual thinking,
for example sexual desire and sexual arousal is probably a unitary concept, or the
latter is preceded by the former (Basson et al, 2005). Please read:
Nur Syazwani Roslan, Nik Ruzyanei Nik Jaafar, Hatta Sidi, Najwa Baharuddin,
Jaya Kumar, Srijit Das & Nik Hazlina Nik Hussain. The bio-psycho-social
dimension of women's sexual desire: 
'Argumentum ad Novitatem'. Curr Drug
Targets 2019, 20: 146 - 157
Rosemary Basson (2000). The Female Sexual Response: A Different Model,
Journal of Sex & Marital Therapy, 26:1, 51-65, DOI: 10.1080/009262300278641
Specific comments:
Regarding abstract.
It was mentioned that, "The mean score of sexual interest/desire among women
who referred to healthcare centers in the city of Sari is estimated as 30.6±10.5.
After adjusting the effect of the confounder variables by logistic regression
multivariate analysis, the age at first intercourse, the length of time spent in
marriage, and the level of satisfaction with income were variables significantly
associated with LSD and HSDD (P < .01)"
It is adequate to mention only "…by logistic regression." without multivariate
analysis, as the latter is part of the former.
It was noted that, "The obtained findings from multivariate logistic regression
between socio-demographic, LSD, and HSDD are indicated in Table 2.As
demonstrated, Our results suggest that the odds of LSD and HSDD are 50% -
60% lower in women with age at first intercourse ≥ 21 (OR:0.56; 95%
CI:0.3-0.9) and (OR:0.4; 95% CI:0.2-0.7), respectively."
Is "≥ 21" a typo? If this is refer to the age, there must be comparison, or if it is
mentioned in the Table, you may omit this.
Regarding introduction. The introduction is fair.
Regarding methods and material. In the methods section, there is an important
ethical issue that need to be resolved. What happened to the respondents who are
suffering from HSDD? Are they offered to seek professional help?
Regarding results.
It was stated that, "Although moderate alcohol consumption and physical activity
were associated with LSD, they were not associated with HSDD. Other
demographic variables were associated with HSDD." My question is, how
widespread the consumption of alcohol in Iran, a Shia but Muslim country? Are
they - the women - permitted to drink alcohol? 
In p. 8, line 39-44, it was stated that, " The odds of LSD diagnosis were 3.1 and
2.1 times higher among those aged 35-40 years (OR:2.1; 95% CI:1.2-3.7) and
over 40 years of age (OR:3.1; 95% CI:1.6-5.8) than women under 30 years.
However, the woman's age was not a factor associated with HSDD.". 
I think it should on another way, i.e. The odds of LSD diagnosis were 2 and 3
times higher among those aged 35-40 years (OR:2.1; 95% CI:1.2-3.7) and over
40 years of age (OR:3.1; 95% CI:1.6-5.8). One decimal point of 0.1 can be
neglected when talking about risk - 2 and 3 times - rather than 2.1 and 3.1 times.
For your Table(s), for example in Table 1, please change all p = 0.000 to P <
0.001, as the former is not existing in the hypothesis testing.
Regarding discussion.
It is interesting the concept of low sexual desire (LSD) dan HSDD was
researched in this study. Please highlight whether LSD and HSDD has any
unique/distinct clinical differences? How much it will help in your understanding
in determining the clinical weightage in handling our patients? 
Do you think the
women can differentiate these two clinical entities, or you think LSD is more
situational (e.g. due to lack of stimulation from the partner/husband, or due to
overwork, etc), and HSDD is more severe form of LSD? The differences that
was mentioned merely on psychometric dimension.
The discussion was segmented into group like BMI, age, etc. I am thinking it is
good if the author can discuss the factors as an interactive manner, rather than
pigeonholed into each factor, i.e. one factor into one paragraph. Suggest
combining all this into one single or two paragraphs. The latter is like writing a
book, and not a journal's paper.
In this section, the discussion totally ignored the role of husband/sexual partner,
which is considered an important domain in determining female sexual
functioning, including her sexual desire. It is important to note that clinicians
should evaluate sexual function pertaining to both partners and encompassing
several dimensions and needing an interdisciplinary approach. The following
study has shown that partner's factor has significant impact on female sexual
well-being:
Grewal GS, Gill JS, Sidi H, Gurpreet K, Jambunathan ST, Suffee NJ. Sexual
desire disorder in female healthcare personnel in M alaysia. Asia
‐
Pacific
Psychiatry. 2013;5: 14-20.
Grewal GS, Gill JS, Sidi H, et al. Prevalence and risk factors of female sexual
dysfunction among healthcare personnel in Malaysia. Comprehensive psychiatry.
2014;55: S17-S22.
Yeoh SH, Razali R, Sidi H, et al. The relationship between sexual functioning
among couples undergoing infertility treatment: a pair of perfect gloves.
Comprehensive psychiatry. 2014;55: S1-S6.
Regarding references.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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