Title: Sexual Dysfunction in Women with Breast Cancer: A Forgotten Aspect among Survivors
Version: 1 Date: 15 Aug 2024
Reviewer's report:
Minor correction on
Introduction
While the background cites relevant studies, it lacks a critical evaluation of existing research. For
instance, what has previous research in Iran or other regions found regarding sexual dysfunction?
What are the gaps or limitations in current knowledge that this study aims to address?
The conclusion, “This study aimed to investigate the incidence of sexual dysfunction and its risk
factors in women diagnosed with breast cancer in Rasht, Iran,” could be strengthened. Briefly
explaining why Rasht was chosen or highlighting gaps in existing research on sexual dysfunction
among breast cancer patients in this specific area would make the rationale more compelling.
Method
While the study design is described as cross-sectional, more details on how participants were
selected (e.g., consecutive sampling, random sampling) could be helpful to strengthen the
understanding of study representativeness.
Although the participants were patients from the clinic, however, The method by which
participants were recruited is not described. Information on how women were approached,
the response rate, and any potential selection biases would enhance the transparency and
replicability of the study.
The methods section does not mention whether a sample size calculation was performed.
Justifying the sample size based on statistical power considerations would strengthen the
robustness of the study’s findings.
The inclusion criteria are somewhat vague, as they only state that women diagnosed with breast
cancer at any stage and with any treatment were included. It would be more robust to specify the
criteria for diagnosis, such as the time since diagnosis or stage at diagnosis, to ensure consistency
in the sample
Although the exclusion criteria are extensive, some criteria such as “vaginitis and urinary
infection” and “systemic diseases” could be further explained. It is not clear why conditions like
vaginitis, urinary infection, or systemic diseases like diabetes would be excluded if the study
aims to investigate sexual dysfunction, as these are commonly related issues in sexual health.
Providing a rationale for these exclusions would clarify the study’s focus.
The explanation of the FSFI tool could benefit from more detail on how it was administered. For
instance, was the questionnaire self-reported, or was it administered by a clinician? Additionally,
the period over which it was used (the last four weeks) is mentioned but could be more explicitly
linked to the time frame for cancer diagnosis and treatment.
While regression analyses are mentioned, it would be helpful to specify the type of regression
model (e.g., logistic regression) used to identify factors related to sexual dysfunction. This detail
would provide clarity on the method employed to adjust for potential confounding variables.
The statistical analysis description is somewhat brief. For example, it states that the Chi-squared
and Fisher Exact Tests were used, but does not clarify which specific variables were analyzed
using these tests. More clarity on which tests were applied to which variables would make this
section more precise.
The analysis description does not mention how missing data were handled, which is a common
issue in clinical research. It would be helpful to specify whether any imputation techniques were
used or if missing data were excluded from the analysis.
Discussion
Although the comparison of prevalence rates is helpful, there is no mention of statistical
significance between the differences reported in various studies. It would strengthen the
discussion if the authors clarified whether the observed differences in sexual dysfunction
prevalence (e.g., 91.9% in this study vs. 84.0% in Iran) are statistically significant or simply
descriptive.
While the paper does reference different countries and their prevalence rates of sexual
dysfunction, it does not delve into how cultural, social, or healthcare factors may influence these
rates. Given that the study is conducted in Iran, where cultural attitudes toward sex may differ
significantly from those in Western countries, it would be beneficial to discuss how cultural
factors might influence the prevalence and reporting of sexual dysfunction. This could include
barriers to discussing sexual health with healthcare providers and the potential stigma associated
with sexual dysfunction
The discussion mentions several risk factors (age, marriage duration, number of children,
menopausal status), but the mechanisms underlying these relationships are not explored in depth.
More information on why these factors contribute to sexual dysfunction could enhance the
discussion. For example, is it due to hormonal changes, psychosocial factors, or changes in
physical health and body image?
Although the authors acknowledge some limitations (e.g., different survival phases, body
changes from mastectomy), the list is rather brief. Additional limitations should be considered,
such as potential selection bias, recall bias, or the cross-sectional design, which limits the ability
to infer causality. The lack of a control group also makes it difficult to isolate the effects of
breast cancer treatment on sexual dysfunction from other unrelated factors.
The conclusion emphasizes the need for healthcare providers to address sexual dysfunction but
lacks specificity. It would be helpful to offer concrete suggestions or recommendations based
on the findings, such as the integration of sexual health counseling in oncology care or specific
interventions that could be explored.