Title: Examining the effect of a sexual self-efficacy based educational intervention on
postmenopausal sexual satisfaction and sexual distress: A parallel quasi-experimental study
Version: 2 Date: 11 Nov 2024
Reviewer:  Giuseppe Caruso
Reviewer's report:
Comments to “Examining the effect of sexual a self-efficacy based educational intervention on
postmenopausal sexual satisfaction and sexual distress: A parallel quasi-experimental study”
Abstract
Original: "We evaluated the effect of sexual a self-efficacy-based educational intervention on
postmenopausal sexual satisfaction and sexual distress."
Correction: "We evaluated the effect of a sexual self-efficacy-based educational intervention on
postmenopausal sexual satisfaction and distress."
Original: "The sexual distress were not difference statistically between the two groups."
Correction: "Sexual distress did not differ significantly between the two groups."
Original: "Conclusion this self-efficacy based educational intervention did not have a significant
impact on the sexual distress of postmenopausal women, although it did lead to a significant
increase in sexual distress and sexual satisfaction scores in the intervention group."
Correction: "Conclusion: This self-efficacy-based educational intervention did not significantly
impact the sexual distress of postmenopausal women, although it did lead to an increase in sexual
satisfaction scores in the intervention group."
Introduction
Original: "Sexual function can worsen with menopause, which is a universal occurrence
experienced by approximately half of the global population."
Correction: "Menopause, a universal phenomenon experienced by approximately half the global
population, can negatively impact sexual function."
Original: "Sexual dysfunction has biological, psychological, and socio-cultural influences."
Correction: "Sexual dysfunction is influenced by biological, psychological, and sociocultural
factors."
Original: "They encompassed reduced sexual responsiveness and frequency, increased vaginal
dryness, and relationship issues during menopause."
Correction: "These symptoms include reduced sexual responsiveness and frequency, increased
vaginal dryness, and relationship issues."
Original: "Partners of women who identify as men frequently face challenges in adapting to their
partner's hormonal and sexual changes post-menopause, perhaps due to the social, religious, and
cultural elements which influence men's viewpoints..."
Correction: "Male partners of postmenopausal women may face challenges in adapting to
their partners' hormonal and sexual changes, potentially due to social, religious, and cultural
influences..."
Method
Original: "A parallel quasi-experimental study was conducted with participants (n=70) including
postmenopausal women presenting to health centers (n=6) and their spouse in Qom, Iran."
Correction: "A parallel quasi-experimental study was conducted with participants (n=70)
consisting of postmenopausal women and their spouses from six health centers in Qom, Iran."
Original: "We used convenience sampling to recruit eligible individuals, who were subsequently
randomly assigned to an intervention (n=35 couples) and a control group (n=35 couples)."
Correction: "Convenience sampling was used to recruit eligible individuals, who were then
randomly assigned to an intervention group (n=35 couples) and a control group (n=35 couples)."
Original: "Questionnaires were completed before, immediately and two months following the
intervention period."
Correction: "Questionnaires were completed before the intervention, immediately afterward,
and two months post-intervention."
Results
Original: "The average score of sexual satisfaction before intervention in the intervention group
was 102.34 ± 21.79, and in the control group was 99.5 ±23. 37."
Correction: "The mean sexual satisfaction score before the intervention was 102.34 ± 21.79 in
the intervention group and 99.5 ± 23.37 in the control group."
Original: "Two months after the intervention, the average score of sexual satisfaction in the
intervention group was 104.83 ± 19.24, and in the control group was 97.67± 24.12."
Correction: "Two months post-intervention, the mean sexual satisfaction score was 104.83 ±
19.24 for the intervention group and 97.67 ± 24.12 for the control group."
Original: "The assumption of homogeneity of variances was examined using Levene's test."
Correction: "Homogeneity of variances was assessed using Levene's test."
Discussion
Original: "However, the exact reason for this low sexual satisfaction is not clear. Yet our data
collection coincided with the COVID-19 pandemic and the spread of the Omicron variant in
the community."
Correction: "The exact reason for the low sexual satisfaction scores is unclear; however, data
collection coincided with the COVID-19 pandemic and the spread of the Omicron variant."
Original: "Thus, future studies of this nature conducted outside of this time period may provide
more trustworthy results."
Correction: "Future studies conducted outside the COVID-19 period may yield more reliable
results."
Original: "In Iran, the attitudes of menopausal women toward their sexual actions and
satisfaction with their sexual life have a significant impact on their interpersonal relationships."
Correction: "In Iran, menopausal women's attitudes toward their sexual activity and satisfaction
significantly impact their interpersonal relationships."
Original: "Self-assessment in sexual behavior also influences the level of commitment and effort
required to achieve a fulfilling relationship."
Correction: "Self-assessment of sexual behavior also influences the commitment and effort
invested in achieving a fulfilling relationship."
Original: "The current study was conducted in the city of Qom. Previous research demonstrates
that menopausal women in Qom are more likely to experience sexual dysfunction, and have
unrelated concerns about potential conflicts in marital relationships."
Correction: "This study was conducted in Qom, where previous research suggests menopausal
women are more likely to experience sexual dysfunction and have additional concerns about
marital conflict."
Conclusion
Original: "Sexual satisfaction scores in the intervention group did not show a statistically
significant increase compared to the control group after the intervention period, but sexual
satisfaction scores in the intervention group showed a significant increase."
Correction: "Sexual satisfaction scores in the intervention group showed a significant increase
over time, though no statistically significant difference was found compared to the control
group."
Original: "However, there was no statistically significant difference in sexual distress scores
compared to the control group."
Correction: "However, no statistically significant difference in sexual distress scores was
observed between the intervention and control groups."
- The choice of control group intervention (a single session on nutrition and physical activity)
may not be equivalent in engagement and impact to the six-week educational program provided
to the intervention group. This disparity might impact the comparative effectiveness.
- Although the study highlights significant interaction effects in sexual satisfaction and distress,
it does not adequately address the potential confounding effect of COVID-19 on participants'
responses.
- The conclusion that the intervention did not significantly impact sexual distress could have
been better contextualized within the framework of cultural resistance to discussing sexual
health, as this could have influenced participants' engagement and openness.
- The interpretation of the non-significant findings in relation to previous literature is somewhat
limited. The authors could discuss whether their findings align or contradict similar studies, as
this would provide additional depth.
Overall, this manuscript provides a valuable contribution to the field of sexual health,
specifically addressing a significant gap regarding postmenopausal interventions in conservative
societies. While the study has limitations related to sample size, methodology, and the
COVID-19 context, it sets a foundation for more extensive research that could confirm
or refine the observed effects of sexual self-efficacy interventions. Future research with
robust methodological designs, greater cultural sensitivity, and a broader participant base will
likely yield more comprehensive findings and contribute meaningfully to the advancement of
postmenopausal sexual health interventions.