Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three hospitals of Northwest Amhara region, Ethiopia: Prevalence and associated factors

Eskedar Getie Mekonnen; Hedija Yenus Yeshita; Alehegn Bishaw Geremew

doi:10.1371/journal.pone.0256015

Peer Review History

Original SubmissionOctober 13, 2020
26 Apr 2021 Decision Letter - Natasha McDonald, Editor PONE-D-20-32177 Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three Hospitals of northwest Amhara region, Ethiopia: Prevalence and associated factors. PLOS ONE Dear Dr. Getie, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Both reviewers raised some concerns with the study methodology and the grammar/presentation of the manuscript. The reviewers' comments can be viewed in full, below. Please submit your revised manuscript by Jun 04 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In the Methods, please clarify that participants provided oral consent. Please also state in the Methods: - Why written consent could not be obtained - Whether the Institutional Review Board (IRB) approved use of oral consent - How oral consent was documented For more information, please see our guidelines for human subjects research: https://journals.plos.org/plosone/s/submission-guidelines#loc-human-subjects-research 3. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. 4. Please ensure you have thoroughly discussed any additional potential limitations of this study within the Discussion section, including the potential impact of confounding factors. 5. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service. Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. 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Upon resubmission, please provide the following: The name of the colleague or the details of the professional service that edited your manuscript A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a supporting information file) A clean copy of the edited manuscript (uploaded as the new manuscript file) 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The present study investigated the prevalence and the associated risk factors for sexual dysfunction in a popluation of men from Ethiopia. The topic is interesting and deserves attention. However, the manuscript is seriously flawed by the poor quality of the English used. I suggest an extensive revision of the English by a specialist to correct the enormous number of mistakes in grammar and typos. The last three sentences of the introduction shoud be move to the discussion Details on the CSFQ should be transferred in a supplementary files to shorten the methods section In the methods, definition of the microvascular complications of diabetes should be given (retinopathy, nephropathy, neuropathy) Do the authors measure the testosterone levels of the participants in the study? Have hypogonadic men been excluded? Have the inteference of drugs interfering with sexual function (i.e. beta-blockers, anti-depressants, etc) been considered? Reviewer #2: This cross-sectional study was conducted among 462 diabetic men in Ethiopia, and sexual dysfunction was found in 69.5% based on questionaires collected. No control group was included, which should be underlined as a major limitation. However, due to the high number of patients included, the manuscript deserves publication after revision. Abstract - Results, line 2: Should "disproportionately" be replaced by "proportionately"? Abstract - Conclusion, line 2: Should "physical activity" be replaced by "lack in physical activity"? Main text - Background, line 28: "hypertension increased the problem". Are you sure it is the hypertension itself? Could erectile dysfunction rather be caused by the anti-hypertension treatment according to e.g. Fedder et al., 2013? Reference list: For at least 10 references, the name of the journal is not mentioned. It should be included. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Maria Ida Maiorino Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0256015.r001
Revision 1
4 Jun 2021 Author Response May 18/2021 Point-by-point response Dear the editor and reviewers, we found your comments to be crucial for enhancing our scholarly work. We are really grateful enough to express our appreciation for your comments. Appreciating your effort and valuable comments, we have provided possible reflections on the raised concerns and questions. Kindly find our response hereunder. A. Editor’s comment 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Authors’ response: comment has been accepted. 2. In the Methods, please clarify that participants provided oral consent. Please also state in the Methods: why written consent could not be obtained? Whether the Institutional Review Board (IRB) approved use of oral consent?, and how oral consent was documented? Authors’ response: Dear, the reason why we could not obtain written consent was as the study never used biological samples from the participants and applied any invasive procedure, we have taken oral informed consent that approved by the Institutional review board committee of the University of Gondar. As per your recommendation, the ethical approval statement has appeared only in the method section of the manuscript and the detail of ethical consideration was presented in the updated version. 3. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. Author’s response: Dear, we had collected the data for the outcome variable using the Changes in Sexual Functioning Questionnaire (CSFQ-14) adapted from the changes in sexual functioning questionnaire short form (CSFQ14) that any scholar can access it online. Similarly, for the independent variables, daily stressful event measurement scale (DSEMS) and relationship satisfaction (CSI), for instance, were taken from the previously published articles that were cited in the main document. We can supply a copy of both the Amharic (local language) and English language tool that we used to collect the data if that is necessary. 4. Please ensure you have thoroughly discussed any additional potential limitations of this study within the discussion section, including the potential impact of confounding factors. Author’s response: comment accepted and the potential limitation of the study has been added in the newly revised manuscript. 5. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service. Author’s response: comment accepted and the language usage has been improved. 6. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Author’s response: comment accepted and the necessary modification has been undertaken. B. Reviewer #1 1. The manuscript is seriously flawed by the poor quality of the English used. I suggest an extensive revision of the English by a specialist to correct the enormous number of mistakes in grammar and typos. Authors’ response: comment accepted and necessary modification has been done. 2. The last three sentences of the introduction should be move to the discussion Author’s comment: comment accepted and the statements have been taken to the discussion section. 3. Details on the CSFQ should be transferred in supplementary files to shorten the methods section. Author’s comment: we appreciate your concern dear, and we have precisely presented it in the methods section. 4. In the methods, definition of the microvascular complications of diabetes should be given (retinopathy, nephropathy, neuropathy) Authors’ comment: comment accepted and it has been modified accordingly. 5. Do the authors measure the testosterone levels of the participants in the study? Have hypogonadic men been excluded? Authors’ comment: Dear, the higher burden of hypogonadism among type II diabetic patients was previously evidenced, which could be one of a pathological pathway for the development of SD. We believe that excluding hypogonadic men in our study would largely affect our study because of introducing bias, in particular, selection bias. Patients with SD might obviously have hypogonadism and excluding these people would severely affect the outcome variable and lead to miss inference. Although measuring the level of testosterone is truly important, we didn’t measure it as the test was not available in the study setting and even in our country. 6. Have the interference of drugs interfering with sexual function (i.e. beta-blockers, anti-depressants, etc.) been considered? Authors’ comment: the existence of other comorbidities along with their medication, as well as other drugs with a possible side effect of SD was examined. The data were collected through reviewing the medical recording of participants as those factors might have confounding effect. Then the medication history was considered to include in the analysis but it doesn’t fulfil the chi-square assumption. We have included the descriptive data on the currently updated document. C. Reviewer #2 1. This cross-sectional study was conducted among 462 diabetic men in Ethiopia, and sexual dysfunction was found in 69.5% based on questionnaires collected. No control group was included, which should be underlined as a major limitation. However, due to the high number of patients included, the manuscript deserves publication after revision. Authors’ comment: Dear, as our primary objective was to investigate the prevalence of SD among men with diabetes, we didn’t consider a control group. Dear, if we had established a control (patient without SD) and case group (participants with SD), the result would have differed from our primary objective (prevalence of SD) and we wouldn’t have estimated the prevalence. Thus, we don’t believe that not considering the control group wouldn’t be the possible limitation of the study. However, we are ready to accept your comment if you are not satisfied with the feedback given. 2. Abstract - Results, line 2: Should "disproportionately" be replaced by "proportionately"? Author’s comment: comment accepted and corrected accordingly. 3. Abstract - Conclusion, line 2: Should "physical activity" be replaced by "lack in physical activity"? Authors’ comment: comment accepted and modified accordingly 4. Main text - Background, line 28: "hypertension increased the problem". Are you sure it is the hypertension itself? Could erectile dysfunction rather be caused by the anti-hypertension treatment according to e.g. Fedder et al., 2013? Authors comment: SD among hypertensive patients are multifactorial. Not only antihypertensive medications have a deleterious effect on an individual’s sexual function rather hypertension by itself have an impact on patients sexual function associated with its effect on the blood vessels of the genitalia. Likewise, as you said, it’s undeniable evidence that anti-hypertensive agents like β-blockers and diuretics could have the potential to further impair an individual’s sexual function through reducing blood flow to the reproductive organs. Moreover, the psychological impact of chronic illnesses are another contributing factor for developing SD. All in all, you are right both factors (hypertension and the drugs) are responsible and they have been included in the study and examined for its association with SD. 5. Reference list: For at least 10 references, the name of the journal is not mentioned. It should be included. Authors’ comment: comment accepted and the names of the journals have been included except for the gray literature. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0256015.r002
22 Jul 2021 Decision Letter - Ishag Adam, Editor PONE-D-20-32177R1 Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three Hospitals of northwest Amhara region, Ethiopia: Prevalence and associated factors. PLOS ONE Dear Dr. Getie, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Sep 05 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ishag Adam, MD, PhD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I have no further comment. The raised issues have been addressed and the quality of manuscript has improved. Reviewer #2: I have no further comments. I think it is a nice paper, which deserves publication. Hope you will continue to work in this field. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0256015.r003
Revision 2
24 Jul 2021 Author Response As there were no concerns and questions raised by both the editor and reviewers, responses are not applicable. https://doi.org/10.1371/journal.pone.0256015.r004
29 Jul 2021 Decision Letter - Ishag Adam, Editor Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three Hospitals of northwest Amhara region, Ethiopia: Prevalence and associated factors. PONE-D-20-32177R2 Dear Dr. Getie, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ishag Adam, MD, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0256015.r005
Formally Accepted
2 Aug 2021 Acceptance Letter - Ishag Adam, Editor PONE-D-20-32177R2 Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three Hospitals of northwest Amhara region, Ethiopia: Prevalence and associated factors. Dear Dr. Getie Mekonnen: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Ishag Adam Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0256015.r006

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