PONE-D-23-39011Female sexual function index for screening of female sexual dysfunction using DSM-5-TR criteria in Thai women: A prospective cross-sectional diagnostic studyPLOS ONE

Dear Dr. Khanuengkitkong,

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Additional Editor Comments:

Dear Khanuengkitkong

the topic of the present article titled “Female sexual function index for screening of female sexual dysfunction using DSM-5-TR criteria in Thai women: A prospective cross-sectional diagnostic study" is very interesting, the paper and the aim falls within the scope of the journal but the article needs major improvements.

The introduction, material and method section and tables should be modified and improved.

The manuscript should be organized better and English should be improved.

I suggest improving the manuscript with the reviewers' comments.

[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: Yes

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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: This is a very interesting article covering female sexual dysfunction in an Asian country which is highly likely to be affected with eastern culture.

The Introduction have addressed nicely the novelty of this study.

There are a few points that need to be addressed:

1. The exclusion criteria includes having a partner with sexual dysfunction. Was it all types and degree of sexual dysfunction? How many subjects were excluded due to this criteria?

Question 10 of the questionnaire assessed partner information. Please clarify what kind of information.

Sexual partner's dysfunction may affect the female sexual function and vice versa. The data on the partner's sexual function and how it differed from the FSD group and non FSD group might be interesting to reveal.

2. The distress score is actually an overall score and did not distinguish each domain/category of FSD. The authors have addressed this as a limitation of this study.

Distress score for each domain is important because in eastern cultures many women are experiencing FSD, however it does not actually causing them distress because sex usually is a taboo matter, it is considered only an obligation to be fulfilled instead of being enjoyed and as long as the women can function in other areas, complaints of FSD are not considered something that would affect their overall quality of life. This should be mentioned in the discussion.

3. The prevalence of GPPD, FOD and FSAID in this study is higher compared to previous studies done in Chile and Brazil. The authors should also compare with the data form eastern/neighboring countries of Thailand and elaborate more on the discrepancies if any.

Reviewer #2: The manuscript authored by dr Patthamaphorn Chongcharoen and colleagues aim to define the optimal Thai FSFI cutoff point for screening FSD using DSM-5-TR criteria in Thai women. Also, a second objective was to determine the prevalence of FSD in Thai women using DSM-5-TR criteria

The article is good and the chapters (Introduction, Material and Methods, Results, Discussions and Conclusions) are well written.

The study is a prospective cross-sectional diagnostic study which include a significant number of 500 sexually active women. Each women was evaluated by FSFI and a semi-structured interview about their overall distress defined by DSM-5-TR criteria.

The results are clear presented in 4 tables and compared in table 5 with resulte from other studies.

The discussions are complete.

I propose to accept the article for publication without changes

Reviewer #3: Thank you for the privilege of reviewing this manuscript. This manuscript reports on a validation study of the Thai version of the FSFI to assess female sexual function. Overall, this paper is well-written; a few minor edits are suggested below, given the lack of a priori criteria.

Table 4

1. Cutoff scores of 23.1, 24.1, and 23.5 are listed, but not for the same groups of participants. Please include all observed cutoff scores for: all participants, age ≤40 years, age > 40 years, premenopause, and postmenopause. It is difficult to see the benefits and limitations of the listed cutoff scores because information is omitted (e.g., women >40 years with a cutoff of 23.1, etc.).

Discussion

A cutoff score of 23.1 for screening of FSD using the DSM-5-TR criteria was considered best; however, this resulted in a sensitivity of 75.6 and specificity of 67.7, which seem a bit low. Nearly a quarter of cases are being missed with a sensitivity of only 75.6, and a third of identified cases are incorrectly identified (specificity of 67.7).

2. Please suggest secondary screeners or alternative approaches to utilizing this screener, given the low sensitivity and specificity values.

3. Please include as a limitation the lack of predetermined criteria to identify appropriate cutoff scores.

4. Please reference other measures with similar psychometric properties given the utilized cutoff score; if other measures do not use a cutoff score with 76% sensitivity and 68% specificity, please justify why a cutoff score of 23.1 is suitable as a screener for this particular measure.

Reviewer #4: I read with great interest the Manuscript titled “Female sexual function index for screening of female sexual dysfunction using DSM-5- TR criteria in Thai women: A prospective cross-sectional diagnostic study “. In my opinion, this topic analyzed is interesting enough to attract readers’ attention.

Although the manuscript can be considered already of good quality, I would suggest following recommendations:

- I suggest a round of language revision, in order to correct few typos and improve readability.

- The authors could extend and improved the discussion by evaluating and citing current evidence about possible therapeutic strategy to improve quality of life and symptoms of female sexual functions. I would be glad if the authors discuss this important point, referring to: PMID 32252962 and 36037664.

Because of these reasons, the article should be revised and completed. Considering all these points, I think it could be of interest to the readers and, in my opinion, it deserves the priority to be published after minor revisions.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

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Attachments

Attachment

Submitted filename: PONE-D-23-39011 review.pdf

Female sexual function index for screening of female sexual dysfunction using DSM-5-TR criteria in Thai women: A prospective cross-sectional diagnostic study

PONE-D-23-39011R1

Dear Dr. Khanuengkitkong,

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.

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Kind regards,

Violante Di Donato, Ph.D,M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The manuscript has been modified with the comments of the reviewers. It is now ready to be published.

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

Reviewer #3: All comments have been addressed

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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

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: Yes

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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

Reviewer #3: Yes

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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: All reviewer's comments have been addressed by the authors. I recommend to accept this article to be published.

Reviewer #2: Dear Authiors,

as mentioned at the first review round I agree with publication in this form.

I find your research well done and the questions from the other reviewers also improved the content.

thank you

Reviewer #3: Thank you for the privilege of reviewing this manuscript; all suggested revisions have been adequately made. I have no further reservations towards accepting this submission.

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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

Reviewer #3: No

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