PONE-D-24-21802Factors involved in vulvar pain during sexual activity and persistence in sexual activity amidst painful experiences.PLOS ONE

Dear Dr. Oesterling,

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Please answer all reviewer comments, even those by reviewer #1

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Academic Editor

PLOS ONE

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4. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

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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

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

Reviewer #1: Yes

Reviewer #2: 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

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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

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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: MINOR REVISION

- place the young average age within the limits and must take this into account in the discussion

- put the description of the self-constructed questionnaire in the tools section and not in the statistical analysis section

- always use the same number of decimals in percentages

Reviewer #2: This study tries to evaluate which psycho-social factors may explain the link between the presence of genital pain and the willingness to have penetrative sexual intercourse in heterosexual women. The authors reported interesting data. First, the presence of a very high prevalence of genital pain (80%) in a general population. Yet this information should be taken in mind and deserves a broader reflection on the female sexuality. Then the authors found a significant association between sexual distress, vulvar pain, and sexual function, with some other psychosocial variables: sexual self-esteem, definition of sex, sexual distress, sexual agency ,autonomous sexual motivation. These relationships were mediated by relationship satisfaction, sexual pain communication, and engagement in sexual intercourse despite pain. I really appreciate this work, which gives to the readers a broader picture of the reasons why women experiencing pain engage in penetrative sex . I think that this work can be very useful from clinical point of view. Here I listed some minor comments.

Introduction

If I correctly understand, this study is aiming at evaluating general painful sensations in relationship to sexual activity or intercourse. For this reason, I suggest adopting the name of “genital pain” rather than of “vulvar pain” (as adopted by the authors) through the manuscript.

Where the authors mention the types of vulvar pain, indicating the “idea of penetration”, I suggest adding the possible diagnosis of vaginismus.

The authors refer to PVI of heterosexual women. It could be also useful to add the information of a lack of data on non-heterosexual couples.

From my point of view, the introduction is too long. I suggest summarizing the central points related to the main topic.

Methods:

The authors have to explain how they structured the items evaluating vulvar pain and sexual intercourse.

It could be useful to add the information about the type of diagnosis related to genital pain and its prevalence. Another important variable is the type of treatment and its efficacy in acting on pain management.

Definition of sexual agency: I don’t understand if the authors adopted only a limited number of the items present in the Hite Report of Female Sexuality.

In the results, I suggest to better define the “restrictive definition of sex”.

I suggest reporting, in the text or with a table, the prevalence of sexual dysfunctions. I think that this data

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: vulvar pain plosone.doc

PONE-D-24-21802R1Factors Involved in Vulvar Pain during Sexual Activity and Persistence in Sexual Activity amidst PainPLOS ONE

Dear Dr. Oesterling,

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.

Could you please address all the reviewer comments and write a rebuttal letter that addresses each point, rather than just a general sentence for all your revisions?

I would also like to mention that review #2 was intended to select minor revisions for the paper.

Please submit your revised manuscript by Mar 21 2025 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: https://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,

Marta Panzeri, Ph.D.

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.

Additional Editor Comments:

Could you please address all the reviewer comments and write a rebuttal letter that addresses each point, rather than just a general sentence for all your revisions?

I would also like to mention that review #2 was intended to select minor revisions for the paper.

[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 #2: (No Response)

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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 #2: Yes

**********

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

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 #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 #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 #2: This study will evaluate, in a population of Dutch students, which psycho-social factors are involved in the painful sexual activity, and in the lack of pain-communication to the partner. The Authors find a very high percentage of young women referring to experience pain during sexual intercourse. In addition, female distress, sexual function and vulvar pain were associated with low sexual self-esteem, low self-motivation for sex, and limited sexual agency. I appreciated this work, even if some concerns are present. Here I listed my comments and suggestions.

How the authors explain the very high percentage of vulvar pain in their sample, compared with the literature data? Have the authors considered to go in depth with the analysis of the prevalence, considering separate sub-groups pf women? I think that sexual experience may profoundly change in 18- or 30-years women.

The authors must explain why they decided to measure sexual motives adopting the construct of sexual scripts.

The part dedicated to the description of sexual scripts should be shortened and more centered on the main topic of the study.

I would like to know if the authors have assesses in the first part of the study the presence of diagnosed sexual dysfunctions, of organic conditions suggesting the presence of pain, or of psychopathological traits/psychiatric diagnoses associated with vulvar pain.

I think that an assessment of partner’s sexual health could be important to detect.

The enrollment of an exclusive population of young women should represent a selection bias. I suggest adding this point to the limits.

I don’t understand if vulvar pain assessment is made with no-validated items. If yes, the authors are invited to explain the methodology for selecting and structuring these questions.

Pleasure evaluation: the authors propose to the subjects the following two questions:” I engage in the following behaviours solely to provide pleasure to my partner; I engage in the following behaviours solely to meet my partner's expectation.” From my point of view, an additional question matching together the two options (self- and partner- pleasure) is necessary.

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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 #2: No

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[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.

Factors Involved in Vulvar Pain during Sexual Activity and Persistence in Sexual Activity amidst Pain

PONE-D-24-21802R2

Dear Dr. Oesterling,

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.

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Kind regards,

Marta Panzeri, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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