Reviewer ’s report  
 
Title:  Trauma, attachment style, and somatization: A study of women with dyspareunia and 
women survivors of sexual abuse  
 
Version: 0 Date: 20 Apr 2017 
 
Reviewer:  Erika  Limoncin  
 
Reviewer’s report:  
 
This is an interesting study evaluating if  attachment style and somatization are related to sexual 
abuse or dyspareunia. In addition, the Authors investigated whether exposure to sexual or non -
sexual abuse may influence anxiety levels, the tendency to develop an avoidant attachment style 
and the t endency to adopt a somatization as a strategy to overcome negative emotions. The 
Authors found that women affected by dyspareunia showed significantly lower levels of anxiety, 
avoidance and somatization, if compared to the group of women referring to be ex posed to 
sexual abuse. Furthermore, it was found a non -significant difference between the group of 
women exposed to sexual or non -sexual abuse in terms of anxiety, avoidance and somatization.  
Although this study explores an important topic in the field of  psychopathology and sexology, it 
presents several critical aspects, which have to be dealt with, before it becomes suitable for a 
publication.  
 
1. In the introduction the Authors have also to consider the association of other sexual 
dysfunctions character ized by insecure attachment style and somatization, such as 
vaginismus (for example, see " Ciocca G., et al. Attachment styles and sexual 
dysfunctions: a case -control study of female and male sexuality. Int J Impot Res. 2015 
May-Jun;27(3):81 -5"). 
 
2. Introd uction: the Authors should better explain why women affected by dyspareunia and 
women referring sexual abuse show an insecure attachment style;  
 
3. Aims have to be explained in a clearer manner;  
 
4. In the conclusions, the Authors declared that "These findin gs emphasized the unique role 
of sexual trauma on perceived bodily symptoms and insecure pattern of attachment 
style". It is my opinion that this conclusion has to be softened, because they have not the 
control on all the variables which might to be involv ed in this critical event, and also 
because attachment style is a construct which develops earlier in the life. For this reasons, 
the Authors might better discuss, for example in the discussion, why women with an 
insecure attachment style are maybe more su bjected to a sexual or non -sexual abuse.  
 
5. Methods: please clarify on which basis have to be selected the specific non -sexual 
traumas (being involved in a car accident, natural disaster, war);  
 
6. Please specify the life period, when the women have been e xposed to the trauma;  
 
7. If it is possible, insert additional information regarding the presence of traumatic 
experiences in childhood;  
 
8. Why the Authors have not utilized the FSFI as a standardized measure for female sexual 
functioning and for the evalu ation of the sexual pain?  
 
9. Please explain the rationale for the evaluation of the possible presence of dysmenorrhea 
in the women. Is this an exclusion criterion?  
 
10. Statistical analysis: I suggest to the Authors to apply the MANCOVA, rather than the 
ANO VA, controlling for the covariates  
 
11. Results, page 7, line 6: please correct the data regarding the significant differences among 
the three groups and the anxiety dimension of attachment;  
 
12. Post-hoc analysis: have the Authors adjusted for Bonferroni correction? Please specify  
 
13. Discussion: please specify why high levels of somatization were significantly lower in 
the dyspareunia group  
 
14. In the discussion, the Authors should explain th e possible impact therapy program has 
had on the study results;  
 
15. Limits. Please clarify which are the risks related to the fact that this is an explorative 
retrospective study.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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 manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the s tatistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially 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 interests 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.  
 
I declare that I have no comp eting interests.  
 
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