Reviewer ’s report  
 
Title: Vaginal health and hygiene practices and product use in Canada: A national cross 
sectional survey  
 
Version: 1 Date: 05 Aug 2016  
 
Reviewer: Dimitri Barski  
 
Reviewer's report:  
 
The authors make a survey on hygiene -related behaviours and products in Canada and the impact 
on vaginal health in Canada.  
 
 
Only female should be included, because in t ransgender there are bias of medical/hormonal 
therapy etc.  
 
 
There is a selection bias due to internet advertisement (Facebook) and voluntary particiaption. 
Younger women are over -represented. How many are postmenopausal and take estrogens?  
 
 
Please add the information on how long or regular the hygiene products were used, the 
exposition time and frequencs are important.  
 
 
There is an interpretation problem, especally in Conclusions. The results of this survey identify 
the high prevalence of vagi nal health and hygiene related behaviours among individuals with 
adverse vaginal symptoms or infections. So it seems that this risk group uses more hygiene 
products, whereas it does not mean that hygiene products have an adverse effect on vaginal 
health. A  prospective or case control study would be appropriate to analyse the correlation 
between hygiene products and vaginal health.  
 
 
One explanation for a possible correlation between vaginal infection and douching would be 
micro -traumas by douching etc.  
 
 
Please  explain the next steps for the evidence based evaluation of the presented topic.  
 
 
Please explain abbreviations: f.e. LGBTQ (line 20).  
 
 
Only 17 references, should be extended.  
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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical revi ew? 
If an additional statistical review is recommended, please speci fy 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 manusc ript: 
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following qu estions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to  the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing i nterests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
no 
 
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I agree to the open peer review policy of the journal