Title: Sexuality and Psychological Well-being in Different Polycystic Ovary Syndrome
Phenotypes Compared with Healthy Controls: A Cross-sectional Study
Version: 4 Date: 11 Jul 2022
Reviewer's report:
Introduction:Need more references from other article in Introduction.
What is the reason of doing this when already so many studies have been done on this issue..howz
it different from other studies? What da lacunae in those studies?
And whats the novelty in you study?
Objectives of the study should be mentioned at the endo the introduction after mentioning the
lacunae or importance of this issue and reason for doing it.
How do you describe sexual dysf?
Page 3_We also investigated the possible factors associated in PCOS women with different
domains. -What factors?..please mention.
Materials and methods:
Please mention the type of study, its settings, and study group
On what mean /proportion difference , the sample size was calculated
The whole page no.5 discussion is not necessary in material and methods section
This discussion in page 6 regarding phenotype is unwarranted in M&M section
We need to use rotterdom’s criteria for PCOS in page 7 instead of FIGO for PCOS
All participants in the present study underwent abdominal ultrasonography. - its difficult to asses
PCOM in TAS...What ultrasound machine was used and probe hertz as you mentioned 60% of
patients are obese and i think it is very difficult to assess ovaries by TAS
Page 11- sexual dysfunction domain is added in HADS Table no.3?
Page 13 there is complete repetition of  the table contents in explanation..
Page 14-These results can be explained by hormonal difference. Lizneva et al. (9) -Please explain
in details how hormonal difference affects sexual dysfunction.
Page 15- The results of our study confirmed the data of Veras et al. (21), who reported a negative
correlation between the intensity of sexual dysfunction and the level of total testosterone, LH
and DHEAS.-Hormonal levels and sexual dysfunction was not analysed in your study?
Page 15- The possible meaning of the negative correlation between sexual function and androgen
levels might be linked to hirsutism, acne vulgaris and subsequent poor body image, leading
to esthetic problems, which may affect the psychosexuality of PCOS patients.--please provide
reference to this statement
Page 16-Kindly mention why anxiety and depression  scores were different in different
phenotypes?
there is lot repetition of results in discussion
Page 17-phenotype B (HA along with polycystic ovaries) had higher HADS scores (more
depression and anxiety symptoms) than the two other phenotypes-- kindly reason out the
differences observed here.
since  Hyperandrogenic effects are also present in Phenotype A..so only  why Phenotype B has
higher HADS scale
Page 18_BMI did not have any significant effect on sexual function. --Kindly reason out for
this observation when all other studies have found positive correlation and 60% of  women in
your study were obese.
paage 19-There is general agreement in the literature that with increasing age, there is a decline
in desire and sexual interest. Also Pul Cabral and colleagues explored women who were in
oldest age group (56-65 years) had significantly higher incidence of sexual dysfunction (51)--
this reference not needed as our inclusion age group was less than 40yrs
Strength and limitation-
Classification of PCOS phenotypes and comparing them with the control group-
This is not novel-classification according to phenotypes and even studying both groups is part
of study not strength of study
Please analyse article properly and mention the strength and limitations properly