‘Elective Surgery’: Linguistic Issues with Trans and Non-Binary Care

‘Elective Surgery’ is broadly defined as a surgery that can be scheduled in advance. ‘Elective’ does not mean ‘optional’, but still conveys a lack of urgency, or being non-essential – a stigma that can be offensive for those waiting for procedures to improve their quality of life.

While ‘elective surgery’ may be problematic to patients waiting for many different procedures, this phrasing may be especially marginalising for those waiting for gender-affirming healthcare.

What is Gender-Affirming Healthcare?

‘Elective surgeries’ in trans and non-binary healthcare refer to several gender-affirming surgeries an individual might undergo to align their body more closely with their gender identity.

Not all trans and non-binary people undergo gender-affirming procedures, and there are many reasons that individuals seek surgery. These include the easing of gender dysphoria, physical safety and societal pressure, amongst others. Those who seek surgical options often face years-long waiting lists, forcing many to obtain private healthcare.

For those who need them, gender affirming surgeries can be essential to physical and emotional wellbeing. A 2021 report found a ‘42% reduction in psychological distress’ and a 44% reduction in suicidal ideation in those who had undergone gender-affirming surgery.

Navigating Gender Identity in the NHS

Patients expect to be treated with respect and dignity, as per the NHS Constitution.

However, trans and non-binary people seeking care routinely report discriminatory experiences. 70% of trans and non-binary people reported being impacted by transphobia when accessing NHS services, with 14% being refused care by their GP because of their transgender status. Over half of those surveyed admitted avoiding seeing their GP when they were ill due to the risk of discrimination.

It is within this hostile environment that ‘elective surgery’ becomes problematic.

Why is ‘elective surgery’ uniquely marginalising to trans and non-binary people?

Healthcare providers supporting patients waiting for ‘elective surgeries’ often understand that these surgeries are not optional. Where there is clear medical value in the patient undergoing the procedure, ‘elective surgery’ becomes an obvious misnomer.

But for gender affirming procedures, staff may not immediately understand the importance of surgery. The perception may be that there is no clear threat to life if the procedure is not completed, and that the procedure is therefore ‘less important’ than others waiting for surgery.

This is exacerbated by the popular perception that being trans or non-binary is a choice that an individual makes, rather than the reality of someone’s existence which would be detrimental to their wellbeing to suppress.

Therefore, the linguistic framing of gender affirming surgery as ‘elective’ may be uniquely stigmatising for trans and non-binary people, as the quality-of-life benefits to surgery are not immediately obvious. This may result in the perception that these surgeries are less urgent, or more of a choice than other types of surgery.

What should we replace ‘elective surgery’ with?

Given the discrimination that many trans and non-binary people report when interacting with the NHS, we should take every opportunity to reduce stigma for gender diverse folks accessing these services. Replacing ‘elective surgery’ with a better term is a small but effective way that we can contribute to a more inclusive healthcare environment.

A less stigmatising term is ‘planned surgery’. This captures the distinction between emergency and scheduled procedures, gives a more accurate description, and does not make an implicit judgement about the urgency or seriousness of an individual’s condition.

This small change could help to challenge discriminatory perceptions of gender-affirming healthcare and build a more inclusive NHS for trans and non-binary communities.

Biography

Finn is a Trans Advocacy Officer/Trans Programme Coordinator (Policy and Research) at the LGBT Foundation.