Title: Scoping review of the association between bacterial vaginosis and emotional, sexual and
social health.
Version: 1 Date: 03 Feb 2022
Reviewer:  Thane Chambers
Reviewer's report:
Thank you very much for your article. It was interesting to read about this topic. I have feedback
which I hope will help to improve your paper prior to publication.
OVERALL
The paper is clearly written, but there are a few areas where the phrasing could benefit from a
careful copy-edit. In particular, the abstract could benefit from this.
I'm curious to know why you choose to use the PRISMA guidelines from 2009 to guide your
review when updated guidelines are available. See Page M J, McKenzie J E, Bossuyt P M,
Boutron I, Hoffmann T C, Mulrow C D et al. The PRISMA 2020 statement: an updated guideline
for reporting systematic reviews BMJ 2021; 372 :n71 doi:10.1136/bmj.n71 The same is true for
the  PRISMA checklist and flow diagram.
I do wonder about the decision to combine both quantitative and qualitative data in this paper,
especially as the qualitative data analysis is described in a very superficial way and, perhaps, a
separate review would have pushed for a more rigorous/thorough analysis of this data.
SEARCH
Based on the author information, there is not a librarian or information specialist included as an
author of this study. This is unfortunate because most of the following feedback would probably
not be applicable if you had included a librarian or information specialist on your team. (1)
There was no search for grey literature performed. Can you please provide justification for that
and include it as a limitation in your study? Unfortunately, none of the databases that were
searched index any grey literature. (2) Web of Science is not a database but a platform that
is made up of several databases including Science Citation Index Expanded, Social Sciences
Citation Index, Arts & Humanities Citation Index. Can you provide the databases and the year
coverage for these databases? (3) Please provide the platform used for your search of Embase
(e.g. Ovid) and the dates covered by this database. (4) What date(s) were the searches run on?
(5) There are some issues with the search queries. (5a) PubMed Search. Thank you for including
the full strategies for each of the databases. I recognize that searching for concepts having to
do with emotional, sexual and social health is difficult and those ideas are encompassed by
a wide variety of terms. But there are a few obvious terms which may have improved your
search strategy. I will keep my feedback here limited to only MeSH terms because a list of
potential title/abstract keywords could become very long and I want to focus on terms which
should have been considered by you as they are located within the controlled vocabulary used
by MEDLINE. Some of these MeSH headings are Social Stigma; Adaptation, Psychological;
Sexual Behavior; Shame; Embarrassment; Affect; Patient Acceptance of Health Care. Another
consideration would have been combining the MeSH heading Vaginosis, Bacterial with the
floating subheading for psychology (px). (5b) The search strategy for Embase does not include
which fields were searched e.g title, abstract, keyword etc. This omission essentially renders the
search strategy useless. Also it does not seem to include any EMTREE terms. EMTREE is the
controlled vocabulary used by Embase. Can you please provide a justification for that decision?
(5c) There are also no fields present in the Web of Science search strategy.
STUDY SELECTION
Please provide justification for having a sole screener for the citations retrieved. Please provide
detail on how the search results were managed e.g  were they downloaded into EndNote,
Covidence, DistillerSR, Excel etc. On pg 4, lines 86-7 a list of the types of studies that were
included in the review are listed. It's confusing because although there are frequent mentions to
the inclusion of qualitative data throughout this paper, the types of studies included would seem
to automatically exclude qualitative studies. In addition to this, the data extracted which is listed
on lines 104-111 does not appear to include qualitative data.
RESULTS
There is no description of how the qualitative data was analyzed e.g. were themes identified and
then pooled? And if so, how did this happen? Was any critical appraisal of these studies done?
I don't see mention of that in the article. I do see mention of issues around the heterogeneity of
the articles in the strengths and limitations section, but it would be clearer if this was addressed
earlier in the paper. Or perhaps the diverse number of topics encompassed by emotional, sexual,
and social health being addressed by this review make data pooling impossible, in which case
perhaps a different type of review should have been considered e.g. scoping review or a proper
qualitative synthesis. I imagine that most readers would automatically expect that women would
face concerns around their emotional, sexual and social health when dealing with bacterial
vaginosis, so perhaps it would be more useful for readers to know about their experiences and
strategies that focus on ameliorating these concerns rather than focusing on the prevalence of
these impacts?