Reviewer’s report
Title: 
Socio-demographic Determinants of Low Sexual Desire and Hypoactive
Sexual Desire Disorder: A Population-based Study in Iran
Version: 
1 
Date: 
02 Jul 2020
Reviewer's report:
Abstract
Conclusion, Line 1: "Some factors are associated" would be clearer than "There
are some factors that are associated" 
Results
This reviewer disagrees with the final statement, that "the most important factors
affecting HSDD were age at first intercourse and Moderate Satisfaction of
income level (P<0.01)" because both categories of more prolonged marriage (6-
10 years and >10 years) had significantly elevated odds ratios (=>3) and p values
were <0.05. 
That is, the importance of a variable is not determined only by
reference to the p-value but also in reference to the magnitude of the odds ratio
and the factor's socio-cultural importance: if prolonged marriage is related to
HSDD, that has important societal and treatment implications. 
Likewise, both (not just one) of the more benign categories of satisfaction with
income (moderate and much) were significantly associated with HSDD at p
<0.01 and the odds ratios for HSDD were markedly reduced, 0.5 and 0.1,
respectively. 
This too has societal and treatment implications.
Also, a comment or another change is in order for the variable Education level,
secondary. 
Apparently, the non-significance (p = 0.06), despite a high point
estimate of the odds ratio of 3.0, is likely due to the small n of 4 cases of HSDD
in the reference sample (primary-illiterate). 
This makes primary-illiterate a poor
basis for calculating odds ratios for the other education levels. 
The other
extreme, "university" education, could be set as the reference point, and odds
ratios calculated for secondary and primary-illiterate. 
If the authors do not
incorporate this change in Table 2, they should at least comment on this
weakness in the data in the Discussion rather than concluding the Results section
without a mention of the importance of educational level to the diagnosis of
HSDD.
Note: Physical activity, in both Tables 1 and 2, has 3 categories, never, rarely,
and "almost." 
This does not make sense: Should "almost" be "almost always,"
"almost every day" or what? 
Discussion
"Faus's study (2009)" should be changed to "Pfaus's review." 
It was not an
original study.
Age at First Intercourse: lines 5-10 express an error: Your statement that your
finding that having first intercourse at a very young age is a risk factor for LSD
and HSDD is not contradicted by the Abdo results cited. 
Abdo found a very
similar result, unless your sentence misstates Abdo's result. 
Lines 15-29: Given my previous comment, this attempt to rationalize differences
between your results and Safarinajad's on the one hand vs Abdo's needs changes.
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