Asking men if they are pregnant is part of an NHS obsession that puts patients at risk, writes Dr MAX PEMBERTON
Hello Sir. Before we proceed, can I just ask you if there is any chance you might be pregnant?
This is not a scenario that I — nor, I would guess, any of my medical colleagues — would ever in the past have expected to face.
Yet as the highly charged debate about gender versus biology airs in Britain — in newspapers and magazines, on TV and radio, and particularly on social media — such questions are becoming a reality.
And it is something we healthcare workers need to get used to fast. Because in the so-called gender wars, the NHS is the front line.
While much of the media discussion to date has centred on people being ‘cancelled’ for their views on gender or their arguments about transgender athletes competing in women’s sport, it is in our hospitals that the practical consequences are being felt.
Take the latest example. Most women of childbearing age will be familiar with routine questions from health professionals about the possibility of them being pregnant before they undergo certain procedures.
Doctors are required to find out if a female patient could be expecting before she receives radiotherapy, undergoes diagnostic imaging or has any treatment or scan involving nuclear medicine because of the potential risks to an embryo or foetus.
Doctors are required to make a note of ask women if they are expecting before undergoing certain procedures (file photo)
According to reports this week, some NHS trusts have started asking male cancer patients and male patients having X-rays and MRI scans if they could be expecting a baby.
This follows the Government’s decision in 2017 to replace the phrase ‘females of childbearing age’ with ‘individuals of childbearing potential’ in the regulations.
The Walton Centre NHS Foundation Trust in Liverpool, one of several trusts to have adopted the practice, says it now asks the question of ‘ALL patients under the age of 60, regardless of how you may identify your gender’ who are scheduled to have procedures that involve radiation.
Some see this as yet another example of ‘women’ being erased from society. It comes after J.K. Rowling caused a Twitter storm when she took issue with a headline about ‘people who menstruate’, and Labour politician Rosie Duffield came under fire for supporting criticism of a tweet that referred to ‘individuals with a cervix’.
It is, of course, hard to disagree with their objections, because increasingly ‘woman’ is becoming a dirty word.
It is seen as bigoted and exclusionary by some because it fails to include trans men who might still have female bodies, including sexual organs.
But I see this latest development, in which men are being asked if they could be pregnant, as emblematic of the knots we are tying ourselves in — especially in the NHS.
At times, what is happening in the health service seems almost Orwellian. This month it emerged that a patient had allegedly been raped by a trans person on a single-sex ward in an NHS hospital.
But when police contacted the ward, they were informed that ‘there was no male [there], therefore the rape could not have happened’, despite CCTV footage and witnesses to the attack.
This is because the legal definition of rape means the crime can be carried out only by a physically intact man — and the alleged perpetrator identified as a woman.
An NHS policy known as Annex B allows patients to be placed on single-sex wards according to the gender they identify as, rather than their sex. It has meant a kind of nightmarish Newspeak has been ushered in under the auspices of inclusivity.
The mantra ‘trans women are women, trans men are men’ is inclusive and celebratory, and I applaud that. But when it comes to medicine, it is simply not true.
Critics are right to say it is ‘clinically dangerous’ to prioritise gender over sex in clinical settings.
The pandemic provided a good example of this, when we discovered that people born male — biological men, if you will — were at increased risk from the coronavirus.
While I was working on Covid wards, I noted that the panicked NHS very quickly dropped the politically correct terminology it had been promoting around gender and simply asked people their sex — because it could be a matter of life or death.
The problem is that as a society, we routinely confuse and conflate gender and sex, so let me spell it out.
While gender is partly socially constructed, sex is a biological fact.
Sex is defined by the size of the gamete (or sex cell) — the individual of the species that produces the smaller gamete is termed male, while the one producing the larger gamete is termed female.
Dr Max Pemberton, pictured here on ‘This Morning’, says people routinely confuse and conflate gender and sex
In humans, that means either sperm or egg.
There is no third or in-between gamete. While I understand how gender can change and indeed may be non-binary (gender identities that are neither male nor female), sex is an immutable and demonstrable biological fact.
It is, by scientific definition, binary and cannot be changed by the way someone presents themself, by hormones or even by surgery. To argue otherwise is fundamentally anti-scientific.
I believe the Society of Radiographers has it right: it recommends that all patients are asked what sex they were assigned at birth, then are questioned on their pregnancy status if they were born female.
This makes sense to me. We shouldn’t assume that just because someone appears as one gender, this is actually their biological sex. So the sex they were assigned at birth should be recorded, along with how they identify.
This means doctors can screen and check for sex-based medical issues while still being respectful and sensitive to a person’s gender identity.
I do not believe the NHS’s obsession with gender ideology is being driven by patients.
All the trans patients I’ve seen over the years have understood that, from a medical perspective, being a trans woman is different from being a born a woman, and that being a trans man is different from being born a man.
They have been open about their gender identity and we have discussed their specific medical needs in a respectful manner.
That is not to say trans people don’t experience prejudice, and often this is born of ignorance.
But from everything I know, the vast majority of NHS staff want everyone to have a good experience of the health service and they work hard to make it happen.
I’ve seen how, to avoid patients being misgendered, staff have discreetly put notes on their medical files to ensure other staff are aware of the patient’s preferred pronouns.
But some in the NHS hierarchy are courting controversy for the sake of it, in a rush to be seen as ‘inclusive’. Instead, they only succeed in causing further division.
We need a compassionate but robust approach that balances the individual’s wishes with the biological reality. It seems to me perfectly possible — and reasonable — to know whether the person being treated is female or male, while still acknowledging and respecting their gender identity.
We should be celebrating trans people for who they are, not wasting time trying to convince ourselves that biological facts are trumped by feelings.
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