Title: KNOWLEDGE, PRACTICES AND BARRIERS TO ACCESS SEXUAL HEALTH
OF WOMEN IN THE MENOPAUSAL STAGES: A CROSS-SECTIONAL STUDY WITH
BRAZILIAN GYNECOLOGISTS
Version: 1 Date: 09 Nov 2023
Reviewer:  Phuc Nhon Nguyen
Reviewer's report:
Dear authors,
Thank you for the great work on this research. The topic is interesting. The study found some
privileged topics related to vaginal lubrication, dyspareunia and sexual dysfunctions compared
to sexual orientation and the woman's relationship with herself in brazilian postmenopausal
women. However, please add the points as below:
- The burden of mid-life health, the symptoms of vaginal bleeding, anemia, and others common
gynecologic diseases in postmenopausal and perimenopausal stage should be expanded.
Particularly, in low-middle income countries. The authors could refer to these papers in low-
resource settings:
+ Nguyen PN, Nguyen VT. Evaluating Clinical Features in Intracavitary Uterine Pathologies
among Vietnamese Women Presenting with Peri-and Postmenopausal Bleeding: A Bicentric
Observational Descriptive Analysis. J Midlife Health. 2022;13(3):225-232. doi:10.4103/
jmh.jmh_81_22
+Nguyen PN, Nguyen VT. Assessment of paraclinical characteristics in peri- and
postmenopausal bleeding women: is there a correlation between hemoglobin levels and
ultrasonic indices?. J Taibah Univ Med Sci. 2022;18(3):488-498. Published 2022 Nov 15.
doi:10.1016/j.jtumed.2022.10.011
- The questionnaire format is missing.
- The inclusion and exclusion criteria needed to be described.
- How the authors determined the clinicians who work in health care with women in
the menopausal transition or postmenopausal?. This is important point to the results. The
menopausal transition, perimenopausal, premenopausal, postmenopausal stage are all different.
The definition is based on age, the hormonal tests, or the symptoms that the partcipants manage
the patients?
- The duration time for completing all the survey and the time to send back the survey.
- The frequency of all social networks that the team had sent for practicians.
- The day off or working day, the mood of day, the morning or the evening may affect to the
response. Did the authors concern on this issue?
- In table 1, regardless of gender identity. I really do not understand the difference between
“woman” and “female”, “male” and “man”.
- The biological sex rate of female clinicians is higher than in male clinicians. The participants
were randomly enrolled or were choosen. Please avoiding the differentiation on sex. This may
be a bias.
- Degree of medical diplome should be included. These include graduation, post-graduation,
master, PhD, professor, etc…
- Regarding “State” variable. The rural/urban or center city/ province is better way to understand
than the name of place. Some readers can not understand “São Paulo” or “Rio de Janeiro” is
the bigger city.
- All the variables such as Health Care System, Level of Care, Sexual Health Approach Method,
etc needed to be defined in Method section.
- Some terms such as public/private health-care system are better way to understand.
- Is the Household income (R$) necessary in this study? The definition and the determination
of this variable is difficult.
- The discussion should be shorter and strength/limitation study needed to add.
- The conclusion should be more focused.
- “According to the professionals, the main barriers to addressing the topic in health settings
are time limitations and patients' discomfort with the subject”. Did the team concerned on the
assessing methods of gynecologists during examination?
- In conclusion, the authors mentioned on  this sentence: “Moreover, female gynecologists
and those with higher levels of knowledge showed higher frequency of addressing sexual
health in clinical practice with women in menopausal stages; thus reinforcing the importance of
investment in training and continuing education of these professionals.”
I disagree with this conclusion. The authors should reconsider this mark. Since the number of
female doctors in the survey is greater than in male doctors (80% vs. 20%) in Table 1. Thus,
this must influence on the other results.
- The decimal number format in Table needed to be revised. Some figures present with “coma”,
others are written by “ dots”, “point”.
- Many references are required to be corrected with English version and style citation. If the
authors could not change to English version. Please delete it.  For examples:
11.Abdo CHN, Oliveira WM Jr, Moreira Junior ED, Fittipaldi JAS. Perfil sexual da população
brasileira: resultados do Estudo do Comportamento Sexual (ECOS) do Brasileiro 2002.
13.Abdo CHN. Quociente sexual feminino: um questionário brasileiro para avaliara atividade
sexual da mulher. Diagn tratamento 2009:89–90.
16.Rodrigues Júnior OM, Costa M. O ginecologista brasileiro e a sexualidade humana: II. A
abordagem da sexualidade da paciente. Reproduçäo 1987:235–9.
17.Vieira TCB, de Souza E, Nakamura MU, Mattar R. Sexualidade na gestação: os médicos
brasileiros estão preparados para lidar com estas questões? Revista Brasileira de Ginecologia e
Obstetrícia. 2012;34:485–7.
19.Abdo CHN, Fleury HJ. Aspectos diagnósticos e terapêuticos das disfunções sexuais
femininas. Arch Clin Psychiatry (São Paulo). 2006;33:162–7. https://doi.org/10.1590/
S0101-60832006000300006.
20.Instituto Brasileiro. de Geografia e Estatística. Censo Demográfico de 2010 2010.
21.Instituto Brasileiro de Geografia e Estatística. Nota Técnica - Sobre a composição da variável
renda domiciliar per capita utilizada na construção e análise da distribuição dos rendimentos na
PNAD Contínua 2019.
22.Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e
adaptação de instrumentos de medidas. Ciência & Saúde Coletiva. 2011;16:3061–8.
26.Federação. Brasileira das Associações de Ginecologia e Obstetrícia. Matriz de Competências
em Ginecologia e Obstetrícia; 2019.
29.Salinas AA, Jarillo EC. La confrontación de la sexualidad en la práctica profesional de
los futuros médicos: la mirada de los pasantes de medicina. Ciência & Saúde Coletiva.
2013;18:733–42.
30.Avasthi A, Grover S, Sathyanarayana Rao TS. Clinical Practice G
37.Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional de saúde 2019: ciclos de
vida. Rio de Janeiro: IBGE; 2021.
After revision, the paper can be reconsidered for publication in Q2 journal as BMC’Women
Health.
I’m looking forwards to receiving the revised paper soon.
Regards,