Is the NHS violating UK anti-mutilation law with transgender surgery?

Can surgery 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 men: metoidioplasty and phalloplasty. In metoidioplasty, the clitoris is freed and enlarged into a small penis, while the labia are incised and rearranged — a form of tissue manipulation that, according to James, strongly resembles 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 carried out at, among other places, the new Chelsea Centre for Gender Surgery and New Victoria Hospital, where the operations are reportedly due to stop as of December 2026. The Tavistock aftercare service — now housed within the North London NHS Foundation Trust — and the NHS clinic TransPlus in Soho are also mentioned 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 otherwise damaging of the female genitalia, 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 used to keep gender-affirming genital surgery outside the scope of the law — without a court ever having assessed whether such a major and irreversible operation genuinely meets the requirement of 'necessity'.

This 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 under 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, subsection 1) and the Domestic Abuse Act 2021 as 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 come under sharper scrutiny 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 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 attached to that body also apply to the body of a natal woman — including the law against genital mutilation.

In other areas too, British law is exploring the practical consequences of that biological definition this year, as demonstrated by the new British code of practice for women's spaces, which requires hospitals and shelters to consider who is granted access to women's wards.

Our analysis: a strong question, not a proven violation

It is important here to distinguish between source and interpretation. Genspect raises a legal question and supports it with the wording of the law — a legitimate and incisive 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 clear 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 that can legally be considered 'necessary' is precisely the question that has not yet been answered by a court — and one that, 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 would directly apply to these procedures, but the underlying question is universal: on what basis is an irreversible intervention in healthy tissue declared '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 at Zelfidentificatie.nl.