Title: Characteristics of Chinese women in need of enhanced sexual health attention and at risk
of hypoactive sexual desire disorder
Version: 0 Date: 22 Feb 2023
Reviewer's report:
BMC Women’s Health Manuscript entitled “Barriers to Chinese women’s sexual health and the
heterogeneity of low sexual desire: An internet-based cross-sectional study” examines the risk
factors and psychological barriers that hinder Chinese women’s willingness to disclose their
sexual health concerns related to Hypoactive Sexual Desire Disorder (HSDD).
The authors utilized binary logistic regression analyses with data derived from an online internet-
based survey with N = 3,443 Chinese women.
Results showed Chinese women with little sexual health knowledge and being ashamed of
having sexual health-related disorders were less willing to communicate their sexual health
concerns. Living with friends was a risk factor for shame regarding sexual health disorders.
Additionally, Chinese women were more likely to report distress related to low sexual desire
when it was due to a medical (e.g., surgery) or mental (e.g., depression) health condition.
Specific comments and recommendations are offered below that I have organized in order of
appearance in the manuscript.
Title: The title reads as barriers to Chinese women’s sexual health rather than barriers to
Chinese women’s willingness to disclose sexual health concerns and their sociodemographics.
The authors may want to consider revising the manuscript title to be clear about what they are
contributing to the literature.
Introduction:
• There is no mention of the current problem. Why are Chinese women having issues with self-
disclosure of sexual health problems? Why Chinese women, in particular? Please add data and/
or literature about the state of Chinese women’s sexual health to better inform readers about
why this is an issue that needs to be addressed.
• There is no distinction made between low desire and HSDD, although it was mentioned that
researchers tend to conflate the two concepts/disorders. Please clarify here.
Methods:
• The quantitative data analyses used were appropriate. However, I have questions about the
measures. First, if the survey questions were coded as “yes” or “no”, how were they answered
on a 5-point Likert scale? Please clarify here.
• Additionally, the age groups seem rather large. For example, 25-year-old Chinese women
may have different risk factors and barriers to self-disclosure compared to 50-year-old Chinese
women. How do you account for any physiological (i.e., menopause), relationship status, and/
or generational differences?
• It would be beneficial to include the number of participants in each age cohort to get a better
understanding of your sample.
Results:
• The results read clearly.
• Page 10, lines 193-195 includes an incomplete sentence.
Discussion:
• Much of the discussion is a regurgitation of the results without any reference to previous
literature on women’s barriers to disclosing sexual health concerns. I would love for you to
support your hypotheses with existing research.
• The health belief model is introduced in the discussion section but was not addressed in the
introduction. Please address it earlier in the paper.
• It would be beneficial to discuss how culture and various cultural factors may contribute to
sexual shame for Chinese women and increase their risk for non-disclosure.
• What would sexual attitude education entail? Say more about this please in the discussion
section.
• An explanation of why intense work, poor family relationships, ad family stressors increase
one’s risk of HSDD is necessary.
• The finding that participants who were more willing to communicate sexual health concerns
were more likely to report sexual distress from low desire seems interesting. Some research
suggests sexual communication can help to alleviate distress and promote problem-solving.
Please explore this unexpected finding more.
• Please check for grammar and missing articles throughout the paper.
• “Ma” and “Lo” should be corrected, page 11 line 225 and page 13 line 258
• Please be mindful of anthropomorphisms (or inanimate objects (study, work, data) having
animate capability). For example, page 10 line 209 has not animate subject
Summary: Thank you for sending the manuscript to my attention for review. I was disappointed
to not read more background about Chinese women’s sexual health and your input on how
cultural factors (e.g., stigma, lack of sex education) and various stressors (e.g., household
income, family responsibilities, sexual problems) impact their sexual desire and willingness to
disclose their sexual health concerns. Overall, I believe your findings are interesting, particularly
with an understudied population; however, your results need to be better situated in existing
literature about Chinese women’s health and women’s hesitancy to disclose their sexual health
concerns. These results also need explanation to contribute to existing conversations about
sexual health, distress, and desire among racially/ethnically marginalized populations. I hope
these comments are helpful to the authors in their work.