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BMJ 2012; 344 doi: (Published 21 June 2012) Cite this as: BMJ 2012;344:e4187

Women report improvements after surgical repair of genital mutilation

Between 1998 and 2009 a single surgeon in France reconstructed the genitals of 2938 women who had been mutilated or cut as girls. The case series, one of the largest so far, suggests that surgery can help at least some women with a history of female genital mutilation achieve an acceptable sex life, free from pain.

Most of the women were from French speaking West Africa, although more than 564 had undergone female genital mutilation while growing up in France. Almost all wanted surgery, above all, to restore their female identity and autonomy. Four fifths were also seeking a better sex life. All had undergone female genital mutilation that removed or damaged the clitoris, at a mean age of 6 years. One of the aims of surgery was to reconstruct a normal clitoris. More than three quarters of the women presenting for surgery (78% (2053/2613)) had never had an orgasm.

Only 866 women (29%) returned for follow-up one year after surgery. About half (414/840) reported improvements in pain. Slightly fewer reported improvements in sexual pleasure (385/834), and 430 now had orgasms. We don’t know how they felt about their bodies after surgery, and future studies should include validated measures of identity, satisfaction with surgery, and global satisfaction with sex, says a linked comment (doi:10.1016/S0140-6736(12)60636-9).

Citicoline fails to enhance recovery from stroke

Citicoline is already licensed in some countries as a neuroprotector for adults with acute stroke. Animal models suggest it can protect surviving neurones close to the infarct and may even enhance repair. Trial results in humans have been mixed, however, and the latest and largest recently found no difference in recovery between people treated with citicoline and controls given a placebo (odds ratio for global recovery 1.03, 95% CI 0.86 to 1.25). Treatment started within …

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