The Aging Vaginal Microenvironment: A Communication Toolkit

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript addresses an important and underexplored topic: the intersection of menopause-related vaginal microenvironment changes and communication strategies for health professionals working with older women. The life-course perspective anf the effort to translate microbiological concepts into practical tools are commendable and represent a potentially valuable contribution.

The proposed structured framework is clear, practical and well organized. The inclusion of concrete tools such as a reproductive history questionnaire, arts-baised activities and tailored educational materilas strengthens the translational relevance of the work. The manuscript is also well written and generally easy to follow.

However, several issues should be addressed to strengthen the manuscript:

1. Given the scope of the journal, the microbiological dimension should be developed in greater depth. The discussion of vaginal microbiome changes remains largely descriptive. Consider including more specific information on microbila composition shifts (e.g. Lactobacillus depletion, increased diversity) and their clinical implications, supported by recent literature.
2. While the framework is well structured, its empirical grounding is not fully clear. Please clarify which elements are evidence-based and which are proposed innovations. Where possible, provide supporting references.
3. Please clarify the ethical status of this work (e.g. exemption category, nature of data collection)
4. Simplify Table 1 for readability
5. Update references with more recent studies where appripriate.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a highly relevant research topic given the increase in life expectancy, as women spend a considerable portion of their life post the menopause. As pointed out, the aspects around sexuality are often overlooked or stigmatized in this population. Developing a communication toolkit to address this issue is a novel approach. This has the potential to influence healthcare practices positively.

The article follows the format, and the sections are complete. However, the manuscript needs significant restructuring.

• The abstract can be modified to a structured abstract.
• The content of the methodology section does not support the objectives. It is advised to put here how the toolkit was developed and refined to arrive at the present form.
• The present content of methodology can be shifted to the discussion.
• Practice implications can be put after the conclusion, with suggestions for future research.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for your careful revisions and detailed responses to the reviewers’ comments. I believe that the concerns raised during the previous review round have been adequately addressed, and the manuscript has improved significantly as a result.

 

I have no further major comments and support the acceptance of the manuscript for publication.