Reclaiming the Hippocratic Oath: The Case for Criminalisation of ‘Sex Reassignment Surgery'

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At long last, there is international debate taking place regarding the medical harms caused to children in the name of gender ideology, in the form of puberty blockers and cross-sex hormones. These experimental poisons have rendered children infertile and left them permanently scarred, physically and emotionally. Children of course must be our priority.

But, what of the adults? What of the ‘final stage’ of ‘transitioning’, namely surgical interventions that are available to people once they turn 18? This has had comparatively little debate. Perhaps that is because we have a general view that adults should be entitled to do what they want with their own bodies.

However, as a psychotherapist, and former lawyer, I have significant concerns with this and believe that we are abdicating our societal safeguarding duties towards vulnerable adults.

Mastectomy. Phalloplasty. Scrotoplasty. Vaginoplasty. Hysterectomy. Orchidectomy. Penectomy. Vulvoplasty. Clitoroplasty. Voice surgery. Jaw Augmentation. Liposuction. Calf Implant. Lip shortening. Brow Lift. Cheek Enhancement. Eye Feminisation. Hairline Lowering. Adams Apple Reduction.

These are just some of the pick n’ mix options for sex re-assignment surgery that exist in the United Kingdom at present.

Many are available on the NHS, using taxpayer-funded services. For those that aren’t, most health insurance policies cover them under the guise of ‘gender re-assignment surgery’. You are unlikely to be covered for an ingrown toenail. But if you want your healthy genitals removed, no problem. For those who cannot be bothered to sit on an NHS waiting list or don’t have health insurance, you can go private, though it will set you back a few quid. Before coming today, I checked the most recent services list at The London Transgender Clinic. Their gold-standard service is the ‘Penile Scrotal Flat Technique’. Consider it a bit of a bundle package. It involves:

‘Surgical removal of the testes. Next, the penile skin and scrotal flaps are inverted to form the lining of the new vaginal canal. At this point a ‘sensate flap’ from the glans penis is preserved to form the clitoris, ensuring erotic sensation. Following this, the anterior scrotal and perineal skin are sculpted into the labia majora and minora. Finally, there is a repositioning and shortening of the urethra to an anatomically appropriate female position.’

All this you can get for the low, low price of just £31,160.

It makes their double mastectomy at £9,365 look like a bargain (and they even throw in a ‘free nipple graft’…I wish I was joking).

Increasingly, as a result, there are crowdfunding pages popping up whereby you can donate to fund someone’s new artificial penis.

These procedures are not a rarity. Last year, it emerged that over 1,000 women every year are sent to have their healthy breasts amputated, on the NHS, for gender dysphoria.

Given the money to be made, it is little surprise that grifting medical professionals have been setting up clinics left, right and centre, to capitalise on the increasing discomfort many have in their bodies. One example of this is Dr Sidhbh Gallagher, who moved from Northern Ireland to Miami to set up her snazzy, Instagram-friendly clinic, offering her euphemistically titled ‘gender confirmation surgery’ to thousands of patients every year. In fact, she amputates so many women’s breasts that she previously dubbed herself: Dr Teetus Deletus.

These procedures fly in the face of foundational medical ethics. Consider the Hippocratic Oath: ‘First Do No Harm’.

Well, I will come onto the significant risks of these ‘procedures’ shortly but first I would like to consider these overarching points:

1. Gender dysphoria, the mental health condition that you must be diagnosed with in order to avail of such surgical interventions is the only mental health condition in existence in which irreversible surgery is performed. There are other mental health conditions in which people want to change their bodies. For example, there is Body Integrity Identity Disorder, in which a patient may feel a particular loathing or disconnection with a limb. There is Anorexia. There is Body Dysmorphic Disorder. The treatment for these? Therapy, support groups, possibly some low-dosage anti-depressants. Not surgical mutilation.

2. This is the only type of surgery in which completely healthy body parts are removed. They are wholly elective – there is no medical necessity whatsoever.

3. This is not mere cosmetic intervention. This is mutilation. The body parts in question, namely breasts and genitals, cease to function altogether (and bring about permanent infertility in many cases).

4. They fly in the face of biological reality, for it is not possible to change sex, which is immutable and chromosomal in nature. All the surgery in the world won’t change this.

5. There are serious concerns over capacity to consent to these procedures, given that suffering from mental ill-health is a pre-requisite to be eligible. I have heard young women say: ‘Well, it’s okay if I regret having my breasts removed because I can always have breast implants later if I want them’ – this is the worrying lack of nuance we are dealing with here.

6. There is no basis in evidence. Take a woman who identifies as ‘non-binary’, for example, who wants her breasts removed. Where exactly is it written down in medical literature that a ‘non-binary person’, whatever that is, doesn’t possess breasts?

7. There is dangerous advertising and glorification of these procedures that is deeply unethical. Euphemistic language, such as ‘top and bottom surgery’ (rather than breast or genital amputation) is routinely used. Well-known brands such as Costa Coffee, Etsy, E45 Cream, Braun, and others, routinely glorify double mastectomy scars in their products and marketing materials. There are even companies who will help you host your ‘top surgery party’, featuring: -“Bye Bye Boobies” cake that you cut with a saw -“Yeet The Mammary Meat” celebration cards and “Guess the Boob Weight” party games. Make no mistake about it, they are profiting on the mental distress of girls and women. The commercialisation of these procedures also raises concerns about informed consent, as clinics will undoubtedly be reluctant to impart full information regarding risks, lest it discourage the sale.

What of the risks? They are numerous. Here are just some:

· Suicidality: A study covering a period of 30 years post-surgery involving hundreds of patients found that those who had undergone surgery had a suicide rate 19 times higher than the control group.

· Infertility. This, surely, speaks for itself.

· Reduced capacity for orgasm - One study showed that around 30% of male-to-female genital surgeries result in the inability to orgasm.

· Vaginoplasty is associated with significant long-term complications. There is a 2% risk of fistula, 14% risk of stenosis (abnormal narrowing of the vaginal canal), 1% risk of necrosis (tissue death) and 4% risk of prolapse. One systematic review found an overall complication rate of 32.5%, which included, on occasion, death. Furthermore, 1 in 5 vaginoplasties requires corrective surgery. Other common and chronic complications include: bleeding, sexual function concerns, vaginal discharge, vaginal tightness, urinary issues, hair in vagina, anatomic irregularities, loss of depth, malodour, numbness and dryness.

· Incontinence: A systematic literature review found that 21% of ‘male-to-female’ patients and 25% of ‘female-to-male patients’ suffered from incontinence as a result of transgender genital surgery.

· Poor Mental Health: A study published last year in the Oxford Academic Journal of Sexual Medicine, looking at over 107,000 patients with gender dysphoria, concluded that those who undergo surgery are at significantly greater risk for depression, anxiety, substance misuse.

· Extreme Pain: Researchers in Canada who analysed the medical records of patients years after surgery and found that over half who had ‘bottom surgery’ were in ‘extreme pain’ 3-5 years after the procedure.

This does not even begin to consider the emotional harm.

I have spoken to many, many ‘detransitioners’ who speak of the never-ending turmoil, resentment and regret they are plagued with once they realise what they have allowed to be done to their bodies. This is unsurprising when you consider the fact that this surgery is pitched as a silver bullet, but it simply cannot deliver, as it promises the impossible because you cannot change your sex.

I will never forget the conversation I had with Ritchie Herron – a brave and prominent detransitioner. He spoke of the moment he regained consciousness following the surgery to remove his genitals. In that split second when he realised his penis and testicles were no longer there, he was flooded with regret and realised that his life as he knew it had been destroyed forever. This is beyond chilling.

So, what of the current legal framework? Well, under UK law, there is a general presumption that reasonable surgery performed in the public interest will avail of the defence of ‘consent’ and is therefore not criminalised. Without the defence, it would be considered Grievous Bodily Harm under the Offences Against The Person Act 1861, punishable by up to a life sentence. Case law has demonstrated that the threshold for GBH is anything which constitutes a ‘really serious injury, including psychiatric injury’.

My own view is that these ‘surgeries’ should instead be compared to forms of extreme body modification and not be able to avail of such a defence of consent.

In fact, I believe that the current lawfulness of these procedures is completely out of step with our legal framework.

A case before the House of Lords (the precursor to our Supreme Court), known as Attorney-General’s Reference No. 6 of 1980, held that consent should be valid only if it is in the public interest to do so.

The UK’s Law Commission investigated the principles of consent to medical treatment and suggested that the exemption to the criminal law does not turn on consent, but rather the purpose for which the treatment is administered; the implication being that the purpose must be therapeutic in order to be lawful regardless of whether consent was adequate. We saw this notion in action in 2017 when cancer surgeon, Ian Paterson, was sentenced to 20 years in prison for performing mastectomies on women which were not medically necessary.

In the Case of R v Brown in 1995, it was held that consent could not be a defence for forms of sadomasochism. This was partly codified into law with the introduction of Section 71 of the Domestic Abuse Act 2021. So, for example, in this country, you cannot consent to strangulation even as part of a consensual sex act.

In the Brown judgment, it was held that lawful surgery must be both consensual and reasonable. We saw the logical end result of this in a Court of Appeal case of R v BM, which involved forms of extreme body modification, including the removal of someone’s ear and nipples, as well as tongue splitting. All completely consensual – the ‘victim’ had actually requested these acts. But the perpetrator was sentenced to 40 months in prison. In the judgment, the following was stated:

‘What the defendant undertook for reward in this case was a series of medical procedures performed for no medical reason’ (does that sounds familiar to anyone?).

There is some need to protect from themselves those who have consented, most particularly because they may be vulnerable or even mentally unwell. Moreover, serious injury, even consented to, brings with it risk of unwanted injury, disease or even death and may impose on society as a whole substantial cost.’

However, the judges went on to say: ‘Yet there is a need to reflect the general values of society which have long accepted tattooing and piercing (not just of ears) as acceptable, along with such things as ritual circumcision, sports and the other sub-categories identified in the cases. That is not to say that each receives universal support from all sections of society, but the exceptions are so deeply embedded in our law and general culture that it would require Parliament to render such activities subject to the ordinary criminal law of assault. The recognition of an entirely new exception would involve a value judgement which is policy laden, and on which there may be powerful conflicting views in society.’

So, a clear statement that these actions should not be lawful but a judgement that it should be for Parliament to create new offences, if it sees fit, rather than trying to change national policy framework via case-law.

That is precisely why we have witnessed legislation introduced over recent years to safeguard people from harm caused under the guise of ‘medical interventions’ and even when the individual claims to have consented to it.

The clearest example of this is the Female Genital Mutilation Act 2003, which created a new criminal offence of FGM, irrespective of alleged consent, and set down a maximum sentence of 14 years imprisonment.

We are in a position in which British citizens cannot consent to be strangled during sex, or to have an earlobe removed or to avail of FGM, whether for religious reasons or otherwise.

On this basis, how on earth can we be allowing people to have completely healthy breasts or genitals amputated, even though there is no medical necessity and the individuals are at best following a social trend and at worst suffering from a severe psychiatric disorder.

And so, on this basis, I do not believe we have any choice other than to create a new criminal offence. I do not have the time to set out the provisions of this offence right now but we would essentially borrow from FGM and other related legislation, which offer a clear and comprehensive roadmap towards criminalising surgical procedures that are not in the public interest and which cannot be consented to.

People being offered breast and genital mutilation in the UK because of their ‘gender identity’ exploits psychological distress, violates the Hippocratic Oath and must be criminalised in order to restore medical ethics and protect vulnerable individuals.