Reviewer’s report
Title: Association between type 1 diabetes and female sexual dysfunction
Version: 1 Date: 24 Dec 2019
Reviewer: Hatta Sidi
Reviewer's report:
The title: The impact of type 1 diabetes on female sexual dysfunction
Overall comments: This study interests the readers in the multi-disciplinary area, especially in the field
of sexology, gynaecology and endocrinology. The writing is satisfactory, but I think it is too ambitious
to state the use of the term "impact". As it is mentioned in the Title, Abstract and Methods section, it
would be preferred to mention the term "The relationship" rather than "The impact" in the Title and
other sections in the writing. The author may suggest some implication/hypothetical assumptions   on
the "cause and effect" in the discussion section. 
I also found that the sample size is small. Hence, it will be difficult to generalize the findings due to the
lesser statistical power that is generated from the nature (methodology) of this study. 
Regarding  Abstract.  The  abstract  is  satisfactory.  The  numerical  values  and  statistics  was  clearly
mentioned. 
Regarding Introduction. The introduction section is fair. Please change the term "impact" to study on
the "association" for objective 3) and 5):
"The current work aims to evaluate: 1) the prevalence of sexual dysfunction in women affected by type
1 DM compared to that in the control group; 2) the correlation between FSD and body mass index
(BMI); 3) the possible impact of previous pregnancies on female sexuality; 4) the correlation between
duration  of  DM,  HbA1C  and  sexual  life  quality;  5)  the  impact  of  different  methods  of  insulin
administration  on  sexual  life  quality;  and  6)  the  possible  correlation  between  FSD  and  diabetes
complications."
Regarding Methods. I have concern on one of the ethical issues that may arise from the study. Have the
affected patients with DM and sexual dysfunction is being referred to get professional help? Please
clarify this pivotal issue. 
Regarding the use of rating scale assessing FSD, is there any reason why FSFI-6 is being preferred
from the original version of FSFI-19 (Rosen et al, 2000)? Despite the brevity of FSFI-6, FSFI-19 is
more comprehensive and benefiting when the investigator is trying to study the domain of sexual
desire, arousal, lubrication, etc.
Regarding Results. The results are clear. 
Regarding Discussion.
It was mentioned  in p. 7 line 21-23 that, "Regarding the type of insulin administration, we observed a
higher prevalence of FSD in women with MDI administration compared to CSII, both for total score
and single items, showing better sexual outcomes in the second group,..." To the author's knowledge
based on his or her experiences and the literature review, what could be the reasons for these findings,
i.e.  higher prevalence of FSD in women with MDI administration compared to CSII?
In the discussion, it is worth mentioning that potential painful coituses due to lack of lubrication and
other complications like foot ulcers are contributing factor for sexual dysfunction, as implicated in
some studies.
Adibah Hanim Ismail, Rawa Bau, Hatta Sidi, Ng Chong Guan, Lin Naing, Nik Ruzyanei Nik Jaafar,
Rosdinom Razali, Marhani Midin. "Factor Analysis Study on Sexual Responses in Women with Type 2
Diabetes Mellitus."Compre Psychiatry, Vol. 55, No. 1, January 2014: S34 - 37
Hasniah Husin, Hatta Sidi, Azlin Baharudin. Depression, Anxiety and Sexual Dysfunction in Patients
with Diabetes Mellitus with and without Foot Ulcer. Int J Med Malaysia, Vol. 16 Issue No.1 June 2017:
53 -65 
Rahmah MA, Noraishah J. Determinants of Glucose Control among Elderly Diabetics in Kulim
Med & Health 2011; 6(2): 78-85
Regarding  Conclusion.  There  should  not  be  reference(s)  in  the  conclusion.   Please  remove  this
reference, or cite in the Discussion section.
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.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
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 statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
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