Title: Women’s experience and perspectives toward genital cosmetic surgery in Erbil city/Iraq:
A qualitative study
Version: 3 Date: 20 Apr 2022
Reviewer's report:
Thank you so much for the opportunity to review this interesting article. I suggest below some
changes with the intention of adapting the text for publication.
Abstract
Methods: I suggest writing this section like this:
"This is a qualitative study, the data were collected through semi-structured interviews with
content analysis through the approach introduced by Graneheim and Lundman (2004). The
sample consisted of nine women who underwent genital cosmetic surgery in the city of Erbil,
Kurdistan -Iraq in 2021-2022".
In addition to this change, I think it is necessary to report what the sample closing technique
was: saturation, exhaustion...
Results: I believe this sentence is unnecessary: After semi-structured interviews which carried
out with participants
Conslusions: the authors suggest the need for further studies on the subject. I think it is interesting
to say which studies seem important to reveal the phenomenon: with the approach of other
participants, with the use of other study methods? and I still ask, what would that possibly add?
Introduction
First paragraph: the authors say which fins surgery is not used for, but I miss describing better
for which fins surgery is performed/indicated.
The second long paragraph is too much, it is necessary to summarize the information.
the third paragraph is also very long, I suggest separating it into two parts by reorganizing the
information and paying attention to two issues, especially:
“After vulvoplasty, most women experience anxiety, depression, and other psychiatric
conditions”
This sentence brings a very important statement, is her reference to 7? If so, I think it's convenient
to bring the reference to the end of the sentence.
“For this purpose, the study was an attempt to investigate into this question: “What is the
meaning of cosmetic surgery in term of genital repair according to participant’s understanding?”
In this sentence the authors brought the guiding question of the study, I believe that it is necessary
to reformulate it to present itself in a clearer and more direct way and in the same way it is
essential that the article brings the description of the aims of the study also in a clear and direct
way.
Patients and methods
Research design
This section needs to have the writing rearranged as I suggested in the abstract.
Study procedures
The word typed needs to be replaced by transcribed.
I think it is necessary to clarify: Who are the experts and observers outside the research?
Sample size and sampling technique
This sentence should go to the results section: “They aged between 21 to 50 years, 7 of them were
employed and office workers, the remainder were housewives. Seven women were married, one
was divorced but had a fiancé, and one of them was unmarried”.
I miss knowing about the environment where the participants were interviewed, how was I
prepared? and about the researcher/interviewer, what is their relationship with the participants?
How was your involvement in the research setting?
Findings of the study
In this section it gets confusing what the purpose of the study was, which actually didn't appear
before either...
Would the authors like to know about the experience and perspective of the woman who has the
surgery or the reasons that led her to have it?
At other times the authors talk about the meaning women attribute to surgery. Then it gets very
confusing, I suggest that the authors rescue the concepts of experience and meaning, choose a
theme and use only it in the whole text, as well as solve and point out what the real objective
of the study was and bring the answer to the objective in the results sections, discussion and
conclusion, in a focused way.
The first main theme:
The speeches of the participants are representative, however, they are very long. these lines can
be reduced without losing the purpose of representing the theme. I suggest that the authors make
this reduction.
What about the subthemes? has representative speeches, what do they contribute to the results?
Discussion
This section is interesting, but it has extremely long paragraphs, this makes the reading
exhausting, I suggest reorganizing it into smaller paragraphs of approximately 5 lines.
In the second paragraph these sentences need a reference:
"Most of those who undergo cosmetic surgeries are female because they become psychologically
anxious if they are rejected by their partners or society due to abnormality in their body".
“Similar to these findings, research has shown that there has been an increase in genital cosmetic
surgeries due to a sharp rise in the anxiety associated with perceived vulvar anomalies”.
Conclusions
The authors suggest the need for further studies on the subject. I think it is interesting to say
which studies seem important to reveal the phenomenon: with the approach of other participants,
with the use of other study methods? and I still ask, what would that possibly add?
I think it is important to bring a reflection on women's sexual rights in the discussion section.
I think it is necessary to characterize each of the 9 women participating in the study, I suggest
making a table of sociodemographic characteristics, showing each one of them.
The authors cite some epidemiological data: Australia, US, UK. I would like to know about
information in Iraq or nearby countries.
In the references section it is necessary to check each one of them and standardize.