Sexual Dysfunction in Female Patients with Type 2 Diabetes Mellitus—Sneak Peek on an Important Quality of Life Determinant

Round 1

Reviewer 1 Report

The authors present a comprehensive exploration of sexual dysfunction (SD) in individuals diagnosed with Type 2 diabetes mellitus (T2DM), an often-understudied topic. They emphasize T2DM's complex nature, characterized as a multisystemic ailment with a global prevalence and enduring complications. A critical point is made about how SD, despite its significant impact on the quality of life (QoL) of those affected, is frequently overlooked in both reproductive-age women and menopausal women with T2DM.

The review adeptly identifies the proposed mechanisms contributing to SD in T2DM patients, which involve a multifaceted interplay of physiological, neurological, vascular, hormonal, and psychological factors. These factors are closely linked to various metabolic and vascular aspects of T2DM, including hyperglycemia, insulin resistance, inflammation, endothelial dysfunction, neuropathy, and hormonal imbalances. Nevertheless, some enhancements are needed to elevate the manuscript's overall quality:

1.     Introduction Significance: The introduction should clearly state the issue's significance.

2.     Conciseness in Lines 80 to 94: The content within these lines could be condensed into a single paragraph for clarity.

3.     Section Heading "Different domains of Female sexual dysfunction": This section requires content revision for greater clarity.

4.     Explaining QoL: It would be valuable to define what the quality of life (QoL) encompasses, elucidating all factors and domains affected by SD.

5.     Separate T2DM Discussion: Separate discussions should be dedicated to Type 2 Diabetes Mellitus, its Global Prevalence, and burden, as well as the chronic complications associated with T2DM.

6.     Elaboration on Mechanism and Manifestations of FSD in T2DM: More detailed explanations regarding the mechanisms and manifestations of Female Sexual Dysfunction (FSD) in the context of T2DM should be incorporated.

7.     Addressing Approaches: The manuscript should discuss approaches to addressing Sexual Dysfunction in T2DM, including Diagnosis and Assessment, Treatment Modalities, Individualized Care, and Addressing Medical and Psychological Factors.

8.     Inclusion of Visuals: Figures (e.g., illustrating T2DM mechanisms), flowcharts (e.g., depicting how T2DM directly and indirectly affects FSD), and tables (e.g., chronic complications of T2DM) can enhance clarity and visual appeal.

9.     Avoiding Repetition: The manuscript contains repetitive sentences (e.g., Page two, line 20, and Page 3, line 39), which should be rectified.

10.  Clarification of Contradictory Statement: On Page 6, line 249, a seemingly contradictory statement needs clarification.

Addressing these points will elevate the manuscript's quality and coherence, providing a more effective exploration of the topic.

Considerable English language editing is necessary. At times, sentences are overly lengthy, and the manuscript lacks fluidity in numerous sections.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

This is a narrative review whose goal was to raise the impact on the quality of life in women with sexual dysfunction and who suffer type 2 diabetes mellitus. However, some corrections need to be made to improve the MS.

1. Lane 61: “Numerous studies have shown that the QoL of patients living with DM is lower than that of not having DM. Furthermore, a higher prevalence of sexual function disorder has been identified in the DM population, which may have a negative effect on QoL [7].” I disagree with this idea because only one work is cited. 

2. Lane 80: “Female sexual disorders can affect women of reproductive age as well as perimenopausal and postmenopausal women.” I disagree with this idea because perimenopausal includes women who are still of reproductive age. This idea needs to be addressed more precisely. 

3. Lane 85: FSD acronym must be defined. 

4. Lane 88: “The prevalence of sexual disorders is similar between older and new publications.” This idea must be expressed in a better way. 

5. Lane 92: “However,a recent study…” To correct punctuation error. 

6. Lane 216: What estrogen? All estrogens or estradiol? 

7. Lane 220: “… which have an impact on vaginal physiology.” Positive or negative impact? What type of impact? 

8: Lanes 224 – 231: This idea is unattractive. The authors should improve their approach of this idea. 

9. Lane 251: Acronyms should be consistent throughout manuscript. T2MD or DM2? Additionally, DM 1 acronym must be defined.

Author Response

Please see the attachment

Author Response File: Author Response.doc

Round 2

Reviewer 1 Report

The authors improved their manuscript significantly, And I recommended it for the publication of its original form.

Minor editing of the English language is required for certain paragraphs.

Author Response

Thank you for your time and effort. We have made all the modifications as per your comments in order to improve the quality of our manuscript.

Best regards, Corresponding author

Reviewer 2 Report

The authors did a good job addressing my concerns. However, they still need to make formatting corrections before they can proceed:

Lane 42: Correct distribution[1]. by distribution [1].

Lanes 29, 30, 63... Define DM acronym. Review through the text.

Authors should be consistent with their use of acronyms. Type 2 diabetes mellitus (T2DM), but on lanes 66 and 70 it appears as T2D.

In relation to the above, in lane 50 the quality of life (QoL). However, they define this acronym again in other lanes (145, for example). Review through the manuscript.

Lane 58: Female sexual dysfunction (FSD). However, they redefine this acronym again in other lanes (120, for example).

Lanes 164 – 184. Check line spacing.

Author Response

Thank you for your time and effort. We have made all the modifications as per your comments in order to improve the quality of our manuscript.

Best regards, Corresponding author