I was recently contacted by an NHS doctor who is concerned about gender ideology and its capture of his profession. Let’s call him Dr J. Following retirement from full time work, Dr J is currently working in A&E as a locum senior registrar. He trained as a surgeon and is a fellow of the Royal College of Surgeons in Edinburgh.
Dr J has an issue with genital surgery, which he believes is being mis-sold to vulnerable people as a solution to their mental distress. He thinks the term neo-vagina is “deceptive” and doctors would be better off describing a neo-vagina as a “deep surgical wound lined with skin” so that patients have a better idea of what they’re getting.
To further aid public understanding of what a neo-vagina is and isn’t, Dr J sent me a table he has created.
| Normal Female Vagina | Deep Surgical Wound Lined With Skin |
| Highly distensible fibromuscular elastic tube. | Non-distensible surgical wound in the perineum (bottom) that tends to contract as healing takes place. |
| Inner lining is NON-KERATINISED stratified squamous epithelium. | KERATINISED stratified squamous epithelium (SKIN) |
| Inner lining designed for moist surface. | Inner lining designed for dry surface (prone to macerate when exposed to prolonged moisture) |
| Has a Lamina Propria layer below the surface epithelium. This lamina propria layer is highly vascular and filled with elastic fibers. This elasticity provides the vagina with the capacity to distend enormously during intercourse as well during child birth. | No Lamina Propria and no elasticity. |
| Lamina Propria is rich with blood capillaries leading to water exiting these capillaries and keeping the vaginal lining moist naturally. | No Lamina Propria layer to provide moisture. |
| Inner Lining has no glands and has no keratin. | Inner Lining has sweat glands, apocrine glands, sebaceous glands, hair follicles and a surface lining of keratinisation. These secretions tend to accumulate leading to maceration and infection as there is no natural mechanism to clean the cavity. |
| Not prone for maceration as the lining is designed to be moist from natural human secretions in vagina and cervix. | Prone for maceration as surface sweat glands, apocrine and sebaceous glands pour out their secretions as well as the transudates that arise from wound. These collections can lead to local abscess formations and sepsis deep inside wound along with bad odour on the person. |
| Lining cells are loaded with glycogen which provide the much-needed glycogen inside vaginal lumen. | There is no glycogen in the wound as there is no lining that can provide glycogen. |
| Lactobacillus which is a commensal bacterium in vagina ferments glycogen to lactic acid and maintains acidic pH around 3.5. This pH prevents growth of pathogenic bacteria and fungus in a normal female vagina. | There is no such mechanism available in the wound leading to growth of harmful bacteria and fungus deep inside the cavity. This can lead to sepsis and premature death. |
| Normal vagina has a vaginal part of Cervix protruding it from its vault. This cervix pours out copious secretions from cervical glands and mucosal cells to cleanse the vagina as well as to provide sufficient lubrication for penis during penetration. | There is no Cervix to provide cervical mucus secretions for lubrication and maintenance of physiology. |
| Normal vagina has a circular and longitudinal muscular layer with contractility as a normal physiological function. This provides for the sensations during intercourse as well during child birth. | There is no muscular layer. |
| Normal vagina has an adventitial layer around the muscle layer. This layer has dense connective tissue with extensive vascular supply and elastic tissue. | No adventitial layer – this is a deep surgical wound lined by skin with no surrounding layers. |
| Normal female vagina has bulbs of vestibule on each side of vaginal orifice. These are oval masses of erectile tissue on each side of the vaginal orifice. | Such bulbs of vestibule are non-existent. |
| Two Bartholin’s glands (greater vestibular glands) are present at the vaginal introitus which secretes copious secretions that help in entry of penis at the start of intercourse. | There are no Bartholin’s glands. |
| Bulbospongiosus muscle surrounds the vaginal opening that helps it keeps closed as well as assisting in erection of clitoris during sexual activity. | There is no bulbospongiosus muscle. |
| Normal female vagina is richly supplied with nerves from the vaginal plexus of nerves. These plexuses are rich in autonomic nerves which supply vaginal walls and contribute to the tumescence of the vaginal vestibule and clitoris during sexual excitation. These vaginal plexus are supplied by both sympathetics and parasympathetics. | No vaginal plexus of nerves as this is a man-made surgical wound lined by a flap of skin. |
And that’s if it goes well. Dr J lists the potential complications:
“Post-op infections and sepsis, necrotising fasciitis, pulmonary embolism, inadvertent bowel and bladder injury, urinary strictures, neovaginal stricture requiring often painful dilatations (life-long), numbness in perineum, fungal and pyogenic infections in neovagina, failure of reproduction/sterility, unpredictable effects on the prostatic tissue, urethral and recto-neovaginal fistulae (this complication can leave the individual with uncontrolled leakage of faeces and/or urine between the legs all the time which can lead to untimely death due to gram negative endotoxic shock).“
Dr J argues that operating on perfectly healthy bodies to even potentially cause these harms has “no justification”.
During our correspondence, Dr J sent me a smiley NHS leaflet about undergoing vaginoplasty (dated 2021). It tells those thinking of getting the chop that the vaginoplasty operation will lead to the “creation of a vagina”.
The leaflet warns that the process “can” cause permanent infertility. Having one’s bollocks removed (orchidectomy) as part of the vaginoplasty process certainly causes sterility. Later on in the leaflet (uploaded below), potential recipients are told that the “creation of a vagina” is actually the “creation of a vaginal cavity/neovagina” of between 4.5″ and 6″ (on average) in length. If there is not enough male genital tissue to line the cavity “an operation using a segment of bowel may be suggested”.
I asked a retired consultant I know to review Dr J’s table and this blog post. He didn’t take issue with any of it, but on the matter of using a segment of bowel for a vaginoplasty he added that this option “is self-lubricating, does not require self-dilatation and can be constructed to any length, unlike the situation using skin of the penis.” Which is interesting. The operation to remove the section of healthy bowel obviously comes with its own risks.
The NHS leaflet you can download below provides more detail about the vaginoplasty process, including the fact that once the operation has been completed, the neo-vagina will need to be dilated for up to 45 minutes three times a day for at least 18 months. The frequency of required dilation will decrease thereafter.
The NHS document also notes common complications from the surgery, some of which reflect Dr J’s list above:
“Pain, blood clots, infection, sutures rupturing, urinary tract infections (UTIs), urinary retention (unable to pass urine), scarring, loss of sensation, loss of sexual function, dissatisfaction with visual appearance of the vagina, clitoris and/or labia, inability to orgasm, urinary incontinence (unable to control the need to urinate), necrosis to skin or clitoris (tissue dying resulting in blackening of the skin or Clitoris), vaginal prolapse, fistula: (an unwanted connection between the vagina and urethra or bowel), urethral stenosis: (narrowing of the urethra, making it difficult to urinate).“
Dr J is calling for a ban on vaginoplasty surgeries until they have been properly scrutinised and ratified. He has written with his concerns to the Healthcare Inspectorate in Wales, the General Medical Council, the Royal Colleges of Surgeons in London and Edinburgh, the Royal College of Physicians and the General Medical Council.
The GMC told him: “It’s not in our remit to give clinical advice or comment on clinical matters, for example on the safety or appropriateness of specific treatments. This is the role of a wide range of other organisations, such as National Institute for Health and Care Excellence (NICE), government health departments and the medical royal colleges.”
The Royal College of Physicians told him it “does not hold, or presently intend to issue, a stated position on this topic.”
The Healthcare Inspectorate Wales told him: “The matters raised fall outside of the remit of HIW and therefore this information will be discussed with Welsh Government, Chief Nursing Officer and Chief Medical Officer. I would recommend that you raise your concerns directly with the Department of Health and Social Services.”
The Royal College of Surgeons Edinburgh (RCSEd) told Dr J: “Whilst your views as a RCSEd member have been noted, the issues you raise are outside of the College’s purview”.
Dr J says: “So far none of the professional bodies I have contacted have given total approval for these [so-called gender-affirming] procedures. Yet the government appears intent on providing these treatments without the complete approval of the relevant professional bodies.”
Coming soon – “So what exactly is a neophallus, then?”
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