Title: Health professionals’ and beauty therapists’ perspectives on female genital cosmetic
surgery: An interview study
Version: 0 Date: 04 Aug 2023
Reviewer's report:
General comments: You have written an interesting and informative paper. However, the
analysis and conclusion in its current form is a bit immature and could be further developed. I
have some comments that may be helpful in achieving this.
Specific comments:
Page 5, first line: This sentence is unclear - what do you mean here (reference 18) – who are
these ‘other ?
Avoid using valuable sentences such as They tend to pathologise the healthy vulva by using
terms such as ‘labial hypertrophy’, page 4.
Page 4: Interesting perspective (It is also claimed, without evidence, that ‘large’ labia minora
cause recurrent infections and an unpleasant odor that will be cured by labioplasty) – could be
discussed with female and male circumcision.
Method: which websites (of professional organizations) and how many? And could you motivate
your rationale for your choice on participants? The word ‘volunteers’ sounds strange here, use
‘participants’ consistently. How did you do ‘purposive recruitment’? Please provide some more
information here. Also you state that you ‘offered semi-structured interviews by telephone’,
which sounds strange as it if the participants were to be ‘offered’ the interviews.  Rather you
should specify how many interviews were done by telephone, etc. and that that the informants
were able to choice the mode of interviewing.
Topic guide: interesting topic guide, but are all participants able to respond to these questions,
meaning do all participants have experience with FGCS or is it merely ‘what they think about
FGCS’? This could be clearer.
Participants:
Here you use a lot of abbreviations, please explain here why you use them (for the quotes as far
as I can see). Could you also describe somewhere what kind of relation/role your participants
had to women who might have genital concerns (whether they would seek help from them if
experiencing genital discontent).
Results:
In general, I have a problem with how you have structured your results. For me, the ‘indications’
and the ‘reasons’ for FGCS are linked together, while the ‘ethical chapter’ is about something
else. The category names also differ much in ‘style’. See if you can rename the categories and/or
find another way to structure all this. Also, I find it strange that you refer to the themes/categories
as ‘discourses’, also because I can not see that for example ‘ethical perspectives’ (or most of the
other categories – expect perhaps the ‘diversity’ chapter) are ‘discourses’. You should consider
renaming – and restructuring – all your categories/discourses.
The title ‘Discourses’ seems dull for a rich material like this, could you come up with a
common theme that covers all the four types? I would also skip what is now within brackets,
it just becomes messy and I cannot see how it is necessary. Also, using the codes for included
participants in the text gives a messy impression, I would limit these codes for when you give
full, indented quotes. Instead, I would write for small quotes in text whether it was said by a
gynecologist, plastic surgeon, etc.
Page 8, mid-page: where you state ‘health professionals’, which health professionals do you
mean? Those who were interviewed or ‘other’ health professionals that your interviewees talked
about?
Indications for FGCS:
I think you lift the abstract levels of ‘Functional, Psychological, Aesthetic’ too early, perhaps this
could be a mini conclusion at the end of this chapter (when you have described how you see the
factors that come up as functional, psychological, etc.). If these are sub-categories, which I think
they are, what is the text above these sub-categories (under ‘Implications for FGCS’)?. Think
of you can structure this chapter better, perhaps the ‘Implications for FGCS’ could be changed
to ‘Functional, Psychological, and Aesthetic implications for FGCS’ and the ’sub-categories’
removed?
Page 10: second paragraph: you write ‘only health professionals associate FGCS with hygine’,
aren’t they (almost) all health professionals? Also, I get an impression that most health
professionals agree with the quote by the cosmetic surgeon under. Is this the case? I have a
problem thinking that gynecologists argue for FGCS in terms of hygiene…
Page 14, mid page: What ‘dangerous solutions’ do you refer to here? Please specify.
Page 19, mid page (under ‘Reasons for FGCS’): In the first paragraph, are these reasons that
came up in the interviews or are they reasons you have found in the literature? Please specify.
Also, explain what the surgeon meant by ‘a proper pubic patch’. The section on ‘inaccurate and
limited representation in the media’ is a bit unclear, what kind of representations do they refer
to? I am curious as to where and what kind of media that represent the vulva…
Discussion:
Was your aim really to derive possibilities for informing clinical discussion? Where do you
answer (or try to answer) this aim?
The second paragraph (last on page 22) concerns method discussion and should be placed
elsewhere (in a separate chapter on methodological discussion).
Please avoid webside links in the text, use foot note or reference instead.
In general, there are some interesting points brought up in the discussion, but these could be
discussed more in relation to other literature.
Good luck with revising your manuscript!