Reviewer ’s report  
 
Title: Subclinical Hypothyroidism Would Not Lead To Female Sexual Dysfunction in Chinese  
Women  
 
Version: 0 Date: 18 Jan 2017  
 
Reviewer: Roisin Worsley  
 
Reviewer's report:  
 
Thank you for asking me to review this interesting manuscript. I think this study would be useful 
for clinicians and is worthy of publication. However, the methods need more detail.I think most 
of the points I raise will be fairly easy to address.  
 
Abstract: Very minor point: in the abstract the cut -off for CVFSFI is stated as >23.45 rather than 
< 23.45  
Intro: The definition of FSD could be more precise/accurate - suggest reference to McCabe et al, 
Definitions of Sexual Dysfunctions in Women and Men: A  Consensus Statement From the 
Fourth International Consultation on Sexual Medicine 2015 February 2016Volume 13, Issue 2, 
Pages 135 -143 
Methods: it is stated that women were recruited from a health promotion that provided 'routine 
checkups for all included women'. Please elaborate - does this mean all women in the local area 
attend every year - if so are they sent reminder? what proportion attend? Or are women attending 
because they have a medical problem or they self refer for preventive care? what is meant  by 
'routine checkup' ie blood pressure check? pap smear? How many women attended the centre 
over the recruitment period? Who recruited the women and asked if they wanted to do the study 
and had been sexually active?  
How did you determine who to approach - or did you approach all women of a certain age?  
What does it mean 'completed the CVFSFI in high quality' ie do you mean completed all 
questions?  
Were questionnaires deidentified? could women have been concerned that the person receiving 
the questionnaire would know whose response it was - this might be a problem if they had 
concern that their primary health care provider at the centre might see their responses.  
As women were completing the questionnaire in a separate room on site with a physician or 
volunt eer nearby to answer questions, how was it dealt with if women changed their mind about 
completing the survey? what if they wanted to complete it at home?  
Thyroid status: please clarify what levels for TSH T3 and T4 you used for defining subclinical 
hypot hyroidism, and overt hypo/hyperthyroidism. what platform was used for analysis of thyroid 
hormones and can you give a brief description of the assays performance eg CV values  
How did you determine menopausal status - it is mentioned in results but not meth ods 
Statistics:can you pls clarify rgarding the logistic regression - did you make separate models for 
FSD and each of the FSFI domains?  
 
Results: the rate of SCH seems high at 15% given the young age of participants - is this usual for 
the area? Is the a rea known for iodine deficiency? pls comment  
I think it inaccurate to say that those with a low score were 'diganosed with FSD' as you rightly 
say the FSFI is a screening tool - consider other terminology such as 'at risk for FSD'  
Table 1 - pls provide per centages in each column. What does it mean parity is 1 for both groups  
Table 3: From the table its not clear what the reference groups are eg for 'medium depression' is 
that compared to no depression or everyone else? where youve referred to HT - do you j ust mean 
TPO positive or do you mean SCH and TPO+  
Are the methods appropriate and well  described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
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