Development of Hindi-Translated Version of the Female Sexual Function Index for Evaluating Sexual Dysfunctions among Individuals with Anxiety, Depression, and Other Common Mental Health Conditions: Experiential Account and Preliminary Findings from India
OM PRAKASH Jhirwal
Round 1
Reviewer 1 Report
A quick revision of the paper will be immensely useful for the final shape of the paper.
Author Response
Reviewer-1
A quick revision of the paper will be immensely useful for the final shape of the paper.
Dear Reviewer, 22/3/23
We appreciate the valuable inputs of the reviewer. Based on the suggestion given by the reviewer, we have relooked into the manuscript and revised it as per the need.
Changes made- throughout the manuscript.
Thanks
Reviewer 2 Report
A very interesting scientific work that will allow you to explore the female population in India. The validation of the standardized questionnaire for assessing sexual function is valid. It was a very difficult task and the authors carried it out correctly. Such research shows that it is very important to discuss sexual health in countries where there is no linguistic validation of the FSFI questionnaire, which is used worldwide to compare women. I congratulate the authors for undertaking this work. I hope to be able to compare the results of Indian women to other female populations in this part of the world. In addition, I encourage the authors to advertise this questionnaire more widely, because it seems to me that sex education as well as the approach to women's sexuality in India is marginalized. Please continue research to determine the statistical population of women and conduct longitudinal studies.
Author Response
Dear Reviewer, 22/3/23
We appreciate your positive and constructive feedback. Your comment will encourage us to work more on this area and come up with the relevant publication.
Changes made- none.
Thanks
Reviewer 3 Report
a. Abstract is adequately written.
b. Keywords are aptly chosen.
c. FSFI has been used in many Indian studies. It is worthy citing those research mentioning about how these tools were used (translated, or translated back translated, validated)
https://www.ijnonline.org/html-article/12201
https://www.jmidlifehealth.org/article.asp?issn=0976-7800;year=2016;volume=7;issue=4;spage=154;epage=158;aulast=Mishra
https://www.researchgate.net/publication/257073471_Validation_of_the_Female_Sexual_Function_Index_in_southern_India
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038814/
d. The authors have included patients with common mental disorder for application of the tool. It is worth mentioning the operational definition of common mental disorders. Is it depression and anxiety disorders only? Or involve other disorders too.
e. There are three healthy volunteers also included in the process, that need to be mentioned. Authors mentioned about the patients with common mental disorders.
Author Response
Reviewer-3
Dear Reviewer, 22/3/23
We appreciate your positive and constructive feedback. We have tried to address the comments made by you. Hereby highlighting the point-wise reply to your comments. The places where changes have been made have also been marked.
- Abstract is adequately written.
- Keywords are aptly chosen.
- FSFI has been used in many Indian studies. It is worthy citing that research mentioning about how these tools were used (translated, or translated back translated, validated)
https://www.ijnonline.org/html-article/12201
https://www.jmidlifehealth.org/article.asp?issn=0976-7800;year=2016;volume=7;issue=4;spage=154;epage=158;aulast=Mishra
https://www.researchgate.net/publication/257073471_Validation_of_the_Female_Sexual_Function_Index_in_southern_India
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038814/
Authors’ reply: thanks for sharing the relevant resource materials (from India) on this area. We have incorporated the findings of Indian literature concerning this topic.
Changes made in: page no 2, line 54-63
- The authors have included patients with common mental disorder for application of the tool. It is worth mentioning the operational definition of common mental disorders. Is it depression and anxiety disorders only? Or involve other disorders too.
Authors’ response: The operational definition of the common mental ds. Include disorders that are commonly seen in clinical practice, usually are of milder nature and not require in-patient admission. The disorders we have included under it are Mental and behavioural disorders due to use of alcohol; Depressive disorders, Neurotic, stress-related and somatoform disorders [Phobic anxiety-, Other anxiety-, Obsessive Compulsive-, Reaction to severe stress, and adjustment-, Dissociative-, Somatoform-, and Other Neurotic-Disorder) currently in remission.
Changes made in: Page no-3 & 4 (Line 135-40)
- There are three healthy volunteers also included in the process, that need to be mentioned. Authors mentioned about the patients with common mental disorders.
Authors’ response: Thanks for raising this issue, we have also included healthy volunteers and those with affective disorders (cyclothymia and bipolar affective disorders) to obtain a wider perspective on the questionnaire. This will ensure a larger utility of the Hindi-translated FSFI.
Page no: page no 3 & 4, line 138-147
Thanks,
Corresponding author
Author Response File: 
Author Response.pdf
Reviewer 4 Report
This is a necessary study that needs to be done. FSFI has been in use for various studies but the adaptation and translation are hardly described. I appreciate that you have followed the guidelines given by WHO well.
A few things need clarification.
How was the panel discussion conducted? was it audio recorded and then transcribed? same question for the patient and caregiver interview?
There are a lot of repetitions that can be avoided in the methods and results.
The table and the text are repetitive explaining the steps involved in the process. The type of sampling for cognitive interviewing needs to be mentioned. in the methods, it is noted that females with CMD and healthy volunteers were included. The table has one woman with BPAD.
The study's limitations/challenges and limitations can be made into one section and written briefly. Any reason for including the lower end of the sample range given for interviewing?
Author Response
Reviewer-4
Dear Reviewer, 22/3/23
We appreciate your positive and constructive feedback. We have tried to address the comments made by you. Hereby highlighting the point-wise reply to your comments. The places where changes have been made have also been marked.
This is a necessary study that needs to be done. FSFI has been in use for various studies but the adaptation and translation are hardly described. I appreciate that you have followed the guidelines given by WHO well.
A few things need clarification.
- How was the panel discussion conducted? was it audio recorded and then transcribed? same question for the patient and caregiver interview?
Authors’ reply: Thanks for raising this point. We transcribed the feedback of the expert panelist (SS, SGh, & SG). The transcription was debriefed among the investigators and the suggestions were incorporated in the updated version of the scale.
Changes made: page no 9, line 238-40
- There are a lot of repetitions that can be avoided in the methods and results.
Authors’ response: Thanks for highlighting this. We agree with the reviewer on this. The purpose of providing greater description was to make reader understanding the nuances of the Hindi-translation and the revisions made on the initial Hindi-translated version of the FSFI. We have thoroughly edited the manuscript and omitted the repetitions.
Change made in: throughout the manuscript
- The table and the text are repetitive explaining the steps involved in the process. The type of sampling for cognitive interviewing needs to be mentioned. in the methods, it is noted that females with CMD and healthy volunteers were included. The table has one woman with BPAD.
Authors’ response: Thanks for pointing this out. We have removed the repetition to make the manuscript more crisp.
We have utilized convenience sampling technique for the cognitive interview. We also involved, apart from the common mental disorders, healthy volunteers and those with affective disorders (cyclothymia and bipolar affective disorders) to obtain a wider perspective on the questionnaire. This will ensure a larger utility of the Hindi-translated FSFI.
Page no: 3, line no 127 & 128 and 138 & 147
- The study's limitations/challenges and limitations can be made into one section and written briefly. Any reason for including the lower end of the sample range given for interviewing?
Authors’ reply: We also wanted to highlight, separately, the challenges that we faced in this study (Hindi-translation of the FSFI) and the inherent limitations of the study, so that readers and researchers can have deeper insights about the topic and nuances of such kind of research. Therefore, we have kept two separate heading for this two sections.
Changes made: none
Authors’ reply: We noticed that the participants were often concerned about the purpose of the study and confidentiality-related clauses. Such apprehension or uneasiness resulted in high non-participation rate or hesitancy in the expression of their responses. This was the reason we had to settle for the lower range of the recommended sample size for the cognitive interview. We believe that the future research must consider the challenges faced in the current study and the limitations to encourage greater participation in research on this topic.
Changes made: line no 13, line no 382-84
Thanks,
(Corresponding author)
Author Response File: Author Response.pdf
Reviewer 5 Report
The authors should go through pattern of original article. Requires to go through before resubmitting.
Author Response
Dear Reviewer, 22/3/23
We appreciate your positive and constructive feedback. We have tried to address the comments made by you. Hereby highlighting the point-wise reply to your comments. The places where changes have been made have also been marked.
The authors should go through pattern of original article. Requires to go through before resubmitting.
Authors’ reply: We appreciate reviewers comments. We have followed a slightly different way to present our research work so as to concurrently describe study’s findings and relevant discussion. Based on the reviewers’ remark we have separately provided results & discussion section. In the discussion part we have also included strength of the current procedure of FSFI-Hindi tool development, challenges faced at various stages of the development of the Hindi- FSFI, limitation of the current study & future directions.
Changes made in: discussion section, page no 11 & 12.
Thanks,
(Corresponding author)
Author Response File: Author Response.pdf
Round 2
Reviewer 5 Report
Mentioned above
Author Response
The reply has been provided in the attached file.
Author Response File: 
Author Response.docx
