Title: Prevalence of chronic pelvic pain and primary dysmenorrhea in women of reproductive
age in Ecuador
Version: 1 Date: 26 Apr 2022
Reviewer's report:
Overall Comments
This is an important study with a tremendous amount of data collected. However, further
information on how the outcomes were defined and asked, and more details are necessary
regarding the statistical approach. Details are provided below.
Background
1. The authors should provide a definition of chronic pelvic pain and clarify how it was
described/asked of the participants
2. The difference between cyclic and non-cyclic pelvic pain is not well described.
3. The authors should provide some background information on primary dysmenorrhea.
Currently the background focuses only on CPP with only a brief mention, in line 98, of primary
dysmenorrhea at the end.
Materials and Methods
4. More information on how the interviewers were trained would be helpful.
5. In line 110, after pre-testing were any significant changes made to the questionnaire? If there
were significant changes, was the new questionnaire pre-tested once more?
6. In line 166, a reliability test was conducted on 10% of your study population. Could you
please clarify/confirm the findings of this reliability test and the degree, if any, of disagreement
in response.
7. In Line 182, please clarify whether pain from sexual intercourse was considered to be part
of CPP.
8. In line 186, please clarify whether “cramps perceived during or shortly before and after the
menstrual period” were considered to be part of CPP and/or primary dysmenorrhea.
9. Please provide further detail on the questionnaire that was used. As this questionnaire has
not been used in other settings, further information on how the questions were phrased and the
response options for the questions would be helpful. If the response options were open-ended,
please clarify how you then coded those responses in any analyses. It may be beneficial to include
your questionnaire as a supplement so the reader is better able to understand how the questions
were asked and the response options a participant could give.
10. The sample size paragraph is confusing. When you state “prevalence of 4%, are you referring
to CPP, or dysmenorrhea? What do you mean by “relative error”?
11. In line 205, a definition for alcohol use disorder is provided, however please clarify how
this was determined in the survey? Were participants asked about their alcohol use or was a
definition of alcohol use disorder provided and then participants asked to respond yes/no?
12. Please provide a short description/information on the reliability of the scales used and
whether or not they have been validated in similar populations to your study population. For
example, a Cronbach’s alpha could be provided.
13. In line 218, when using the Pain Catastrophizing Scale for catastrophizing, what were the
cutoffs and how were they determined for high, low, etc. ?
14. We do not know what proportion of those with CPP also have dysmenorrhea and vice versa.
Perhaps organizing the analysis by those with CPP only, those with dysmenorrhea only, those
with both, and those with neither would provide more insightful information.
Results
15. In lines 241 – 252, please clarify what variables you ended up adjusting for in these models
as it is not clear based on the text/tables.
16. In line 255, please note that the 95% CI provided for the mean difference does not contain
the estimate provided.
17. In line 261, please note that the 95% CI provided for the mean difference does not contain
the estimate provided.
18. In Table 4 of your results, please add in how many of your participants also had CPP
19. Please do not bold “statistically significant” results. A lower confidence interval of, for
example, 0.95 does not mean the point estimate is not clinically important.
20. Please limit your risk estimates to no more than 2 decimal places. The data cannot possibly
provide more precision than that.
Discussion
21. It is difficult to interpret the discussion until the comments above are addressed.