Reviewer’s report
Title:  COITAL RESUMPTION AFTER DELIVERY AMONG OASIS PATIENTS. DIFFERENCES
BETWEEN INSTRUMENTAL AND SPONTANEOUS DELIVERY
Version: 0 Date: 23 Oct 2019
Reviewer: Ibrahim A.
Reviewer's report:
Dear Respectable Editor 
Thank you to give me the opportunity to review the manuscript entitle (COITAL RESUMPTION
AFTER DELIVERY AMONG OASIS PATIENTS DIFFERENCES BETWEEN INSTRUMENTAL
AND SPONTANEOUS DELIVERY).
The study designed to compare coital resumption and the variables influencing this activity after
delivery in women with and without a history of obstetric anal sphincter injury (OASIS) and according
to the mode of delivery. 
The study was a retrospective observational case-control study at 6 months  postpartum with 318
women: 140 had a history of primary repaired OASIS and 178 women without OASIS. Patients were
asked about coital resumption and completed the validated specific Pelvic Organ Prolapse/Urinary
Incontinence Sexual Questionnaire-12 (PISQ-12). The authors found that after a spontaneous delivery
(SD), patients without OASIS showed a higher percentage of coital resumption than those with OASIS
(98% vs. 77%; p=0.003), and the PISQ-12 score was also higher (p&lt;0.001). PISQ-12 score was
better in women with SD compared to those with operative vaginal delivery (OVD) (p&lt;0.001),
independently of the history of OASIS. 
The authors concluded that women with OASIS resumed coital activity later than women without
OASIS. Women with OVD resumed coital activity later, and had lower PISQ-12 score than women
with SD.
In  the  background  section  the  authors  mentioned  the  magnitude  of  the  problem  (Obstetric  anal
sphincter injuries (OASIS) involve a severe perineal injury with anatomic and functional consequences,
which can affect sexual activity and function. OASIS seems to be an independent risk factor for sexual
dysfunction and postponed intercourse resumption after delivery).
In the methodology section the authors identified the cases and controls (Women who had OASIS
identified and repaired intrapartum were eligible for the study group. A cohort of women without a
history of OASIS were eligible for the control group). In addition; they mentioned the exclusion criteria
(the exclusion criteria included patients with a history of OASIS in previous deliveries, twins, delivery
by CS or inability to comprehend questionnaires).
The  authors  used  a  validated  self-administered  questionnaire:  The  Pelvic  Organ Prolapse/Urinary
Incontinence Sexual Questionnaire-12 (PISQ-12) and their outcome was coital resumption and sexual
function at 6 months postpartum. 
They used Two expert uro-gynaecologists to perform a gynaecological examination and assessed pelvic
floor muscle (PFM) strength, by digital vaginal palpation, according to the Modified Oxford Grading
Scale (MOS).  Intrapartum identification and repair of OASIS was performed by a senior obstetrician
according to the guidelines of the Royal College of Obstetricians and Gynaecologists (RCOG).
The authors specified the sample size and the statistical methods used to analyse the collected data.
In the discussion section the authors compared their findings by other authors findings, and they used a
relevant references in the discussion section. At the end of the discussion they mentioned the strength
of the study and the limitation faced during their study.
In the conclusion section the authors suggested future research directions (further prospective studies
are needed to provide more in-depth knowledge of female sexual function after delivery considering
not only physical factors but also social and psychological aspects).
Strong points 
large sample size and the detailed analysis according to the mode of delivery, including a great number
of forceps deliveries. The follow-up at 6 months postpartum differs from the short-term evaluation
performed in most of the previously published studies and provides new data. A post-hoc analysis
showed that the sample size.
Minor points 
Typing errors which is yellow highlighted which need revision from the authors.
Long Keywords (also should be revised by the authors).
Overall 
The study is well-designed with large sample size and long follow-up.
It can be accepted for publication after correction of the minor points.
Please, see the attached PDF file 
Regards 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
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 recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
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