CMDA's The Point

Inconsistent Ideology from ACOG

May 30, 2024
A cute little Caucasian boy waits in the childrens hospital ward to be taken back for surgery.  He sits on the edge of his hospital bed, drawing in a coloring book with crayons while waiting for the doctor to arrive.

by Steven A. Foley, MD

How can the American College of Obstetrics and Gynecology (ACOG) fully support gender-affirmation surgery but strongly condemn female genital mutilation?


The ACOG Committee Opinion 823 from March 2021 claims vaginectomy, removing the vagina, is a standard of care procedure for those seeking to change their gender. They reference the Pediatric Endocrine Society and the AMA Journal of Medical Ethics from November 2016, which state that no mental health evaluation is necessary for adolescents prior to medical or surgical treatment. There is no age restriction for surgical intervention because patients “may do better having the surgery earlier.” No data supports this claim. They do state more research should be done.


The conclusion we must draw from this opinion is that ACOG fully supports the removal of an adolescent’s vagina without any age restriction, if this is the procedure she requests.


What is interesting is that ACOG is strongly opposed to the practice of female genital mutilation (FGM), a cultural practice commonly found in parts of Africa that involves partial or total removal of the external female genitalia thought to prepare girls for adulthood and marriage. In their policy statement, they state that FGM or female circumcision should be recognized as a human rights violation and is considered an extreme form of discrimination against women. They also state that under U.S. Federal Law 18 US Code §116 that it is illegal (or criminal) to perform FGM on anyone under the age of 18.


Let us compare the two procedures: one group of girls is left without a vagina, and the other group is left missing parts of normal external female genitalia, but still with a vagina.

In both scenarios, they are asking for the procedure. These procedures may be performed without the patients’ consent, but many consent to this procedure due to the strong cultural tradition associated with it.


In both scenarios, their anatomy is permanently altered.


However, ACOG totally supports gender-affirmation surgery and totally condemns FGM. How can an organization claiming to champion women’s health not totally condemn both for adolescent girls?


We have a long history of understanding the effects and complications of FGM, but we do not have that history with vaginal removal in young girls. In fact, most countries that have been performing gender-affirmation surgery are now suspending these procedures, because adverse effects have become evident. ACOG is not “following the science.”


In the Archives of Sexual Behavior in April 2024, an article entitled “Puberty Suppression for Pediatric Gender Dysphoria and a Child’s Right to an Open Future” states the benefits that organizations like World Professional Association for Transgender Health (WPATH) are promoting are just not supported by the available data. For example, this article totally debunks the idea that children with gender dysphoria who do not transition are more susceptible to suicide.


The fact that ACOG states they are a science-based organization, and yet they are this inconsistent when it comes to adolescent female genital surgery, just indicates that ideology is more important to them than science. Nevertheless, should we be surprised since they regularly avoid using “women” and instead say “people who menstruate?”


  1. Avatar Nicole Hayes on June 10, 2024 at 9:46 am

    Well said, Dr. Foley. Thank you!

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