Is the NHS Violating UK Anti-Mutilation Law with Transgender Surgery?

Can an operation offered as ‘gender-affirming care’ also fall under the definition of female genital mutilation? Journalist Daniel Howard James raises that question on 17 September 2026 in an essay for Genspect, the international organisation that conducts critical research into gender care. His answer: possibly, and the law itself contains the exception that allows it.

What exactly is being claimed

James focuses on two procedures offered to young natal female patients who identify as male: metoidioplasty and phalloplasty. In metoidioplasty, the clitoris is released and enlarged into a small penis, while the labia are incised and rearranged — an act that, according to James, bears a strong resemblance in terms of tissue alteration to infibulation, a recognised form of female genital mutilation. Phalloplasty goes further, removing the female genitalia and using skin tissue from elsewhere to construct a penis.

According to the essay, these procedures are performed at, among other places, the new Chelsea Centre for Gender Surgery and New Victoria Hospital, where the operations are reportedly due to cease as of December 2026. The Tavistock aftercare service — now part of North London NHS Foundation Trust — and the NHS clinic TransPlus in Soho are also discussed in the essay as places where the pathway towards these operations begins.

The law: an exception that explains the problem

The Female Genital Mutilation Act 2003 prohibits the complete or partial removal, incision or other damage to the female genitals, replacing the earlier Prohibition of Female Circumcision Act 1985. However, the law contains an exception for procedures that are ‘necessary for the physical or mental health’ of the patient. James argues that this very exception is being used to keep gender-affirming genital surgery outside the scope of the law — without a court ever having determined whether such a serious and irreversible operation genuinely meets the requirement of ‘necessity’.

That is an important distinction: the essay does not conclude that a court has already convicted the NHS. There is no case law that has brought metoidioplasty or phalloplasty within the scope of the FGM Act 2003. James points to a legal opening, not an established violation. In this context, he also refers to the Gender Recognition Act 2004 (section 9(1)) and the Domestic Abuse Act 2021, laws in which the definition of sex and the protection of women against physical violence are similarly under pressure.

Why this is becoming relevant now

The legal basis for ‘sex’ in British legislation has already been brought into sharper focus this year. The UK Supreme Court ruling in the For Women Scotland case determined that the terms ‘woman’ and ‘sex’ in the Equality Act 2010 refer to biological sex, not to a self-ID status. That ruling did not concern the FGM Act, but it does confirm the broader principle on which James relies: if the law defines ‘woman’ on the basis of biology, then the protective laws linked to the body of a natal woman also apply to that body — including the law against genital mutilation.

In other areas too, British law is now examining the practical consequences of that biological definition, as shown by the new British code of practice for women’s spaces, which requires hospitals and shelters to consider who should have access to women’s wards.

Our assessment: a strong question, not a proven violation

It is important here to distinguish between source and analysis. Genspect raises a legal question and supports it with the wording of the law — a legitimate and pointed way to expose a blind spot in oversight. But the essay provides no court ruling, prosecutorial decision or official investigation establishing that the NHS is actually in violation. What is established is that metoidioplasty and phalloplasty involve the irreversible removal or rearrangement of healthy tissue from natal women, based on a diagnosis that, according to the Cass Review, has a weak scientific basis for the long term. Whether this may legally be considered ‘necessary’ is precisely the question that has not yet been answered by a court — and which, as this essay rightly suggests, should be tested rather than silently assumed.

What this means for the situation in the Netherlands

The Netherlands has no equivalent of the FGM Act that directly applies to these procedures, but the underlying question is universal: according to what standard is an irreversible intervention in healthy tissue deemed ‘medically necessary’, and who assesses that objectively? The same question arises in the debate over the Dutch quality standard for transgender care, where critics point to similar gaps in independent assessment.

Sources

• Daniel Howard James, "Is the UK's National Health Service Breaking FGM Law?", Genspect, 17 September 2026. genspect.org/is-the-uks-national-health-service-breaking-fgm-law
• UK Supreme Court, For Women Scotland Ltd v The Scottish Ministers, 16 April 2025 — summary on Zelfidentificatie.nl.

Edward Jansen

Genderinfo.nl