There is a shorthand term for the moment when someone who once believed gender mattered more than sex changes their mind. “Peaking” describes the point at which a person stops accepting the prevailing narrative because they have seen that sex matters.

It’s often described as a single moment of revelation, which interests me because I haven’t experienced it.

About a million years ago, I worked with a person who declared at work that, from Monday, they would be presenting as the opposite sex. I have to say that the workplace seemed to handle it very well. A new changing room was established so this person was not intruding on the space of the actual opposite sex staff, those outwith our department were accommodating and polite, welcoming, even. This person was shy and quiet and, if they had come out as homosexual, nobody would even have blinked. But, as it was, some eyebrows were raised because gender was quite a novel concept in the mid ‘90s, we had all just assumed this person was gay. That would have been of as much interest to the department as my heterosexuality, as in, of none whatsoever.

Unfortunately, someone told the press that a “transsexual” was working on the wards and there were a few unpleasant mornings having to walk through a press pack with journalists aggressively trying to suss out who it was.

However, I never really understood what the purpose of this attempt at transition was. A department of physios were all fairly up to speed with anatomy and physiology - we all knew that humans could not change sex, but we accepted our colleague regardless of what was going on in their personal life. That was easy to do in the Olden Days, the ones before you were obliged to bring your whole self to work.

This person changed their personal style, displayed new mannerisms and, eventually, developed new secondary sex characteristics. I was comfortable with who this person said they were but I never perceived them as being what they said were.

It seemed to me that “transition” was an awful lot of effort for very little return. It seemed to rely on colleagues being polite enough to indulge this person’s insistence that a new name and hairstyle was their metamorphosis into an entirely new sex class. I couldn’t see that, but the whole thing was none of my business, so I got on with my work.

I heard recently that this person is doing well, thirty years on, and is happy. Which is good news, and I find it reassuring to hear that transition can have positive outcomes - because what I usually read is pretty bleak.

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There are different triggers for “peaking”, but there is a common pattern of “once I saw it, I couldn’t unsee it”.

Sarah Phillimore (crowdfunder link) and Al Peters collected a heap of them in their book, Transpositions. Essays in the book describe a feeling of unease as an anti-science and anti-women’s rights agenda swiftly influenced government, academia, the media, arts, justice and health, and demanded that those who don’t agree be punished and silenced. Many came to realise that “Be Kind” was a misnomer, because disagreement - even if polite and evidence-based - is exaggerated and portrayed as hatred. If you notice that then the principles of gender ideology and its consequent harms for safeguarding and women’s hard-won rights become hard to ignore.

Of course, there are many stories where the ramifications of peaking were huge - loss of family, romantic and friendship relationships or paid work. No wonder people avoid considering evidence and speaking up. Peaking is, to borrow Cass’s 2022 description of social transition, “not a neutral act”. In the very next paragraph of her Interim Report, Cass added: “It should also be recognised that ‘doing nothing’ cannot be considered a neutral act.” Yip, not peaking is also not neutral, you have to master cognitive dissonance, which doesn’t seem to my skill at all.

I enjoy the clear conscience and clarity of thinking that come from not having to jump through hoops before the words I want to say tumble out of my pretty little head. I say what I mean and I mean what I say. Recommend, 5 stars.

The stories in Transpositions often seem like Jenga: one little brick is removed and the whole edifice collapses; sometimes immediately and sometimes it takes a few more wobbles. Recognising one truth - for example, that males are bigger, faster and stronger than females - clarifies that allowing even one male into women’s sport destroys the competitive, social and private spaces that women built for ourselves. Once the impact of males in women’s sport is understood, it becomes hard to not see that placing males in prisons has a negative impact on incarcerated women, and that adding fear, the threat of violence, or bodily harm to a woman’s custodial sentence is not how a civilised society operates.

So when a young family member recently shared with me that they know that sex is real, immutable and sometimes matters, I felt huge relief that our relationship is not going to be a casualty of the gender wars and then wondered why it seemed like a big deal to this person to share with me that they are a sex realist. Once upon a time, “coming out” meant telling people something unexpected about yourself that might carry risk. Does it really now include confessing that you know sex is real and sometimes matters?

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This young person and I have chatted many times about the conflict between sex and gender. Their views were entirely at odds with mine, but we didn’t squabble over it, it was more an enthusiastic, co-operative debate.

Eventually, we both chose three resources and agreed to genuinely engage with each other’s suggestions.

My three resources were video-based:

Dysphoric: Fleeing Womanhood Like a House on Fire (2021), by Indian filmmaker Vaishnavi Sundar.

It is a compassionate exploration of why increasing numbers of young people, particularly girls, experience gender dysphoria, and questions whether medical transition should be the default intervention.

Adult Human Female, by Deirdre O’Neill and Michael Wayne.

A documentary whose screenings at Edinburgh University were cancelled twice because it was perceived to be beyond the pale to reflect on single-sex spaces, safeguarding, free speech, the law and the impact of gender identity policies on women. The filmmakers are taking their trade union, the UCU, to court over its role in the cancellation of their film, their crowdfunder is here.

Lastly, Magdalen Berns’ YouTube, which is peak peak material. Magdalen was like a sweary Miss Jean Brodie in a hoodie, I could imagine her saying in Maggie Smith’s clipped tones “Give me a terf at an impressionable stage and she is mine for life.” She was the first person I came across who was shamelessly uncompromising in her language and analysis of gender theory, particularly its impact on lesbian women. Magdalen made a lasting impression on many.

My homework was Philosophy Tube, a person who uses philosophy and personal autobiography to discuss gender to nearly 2 million youtube subscribers; Contrapoints, who has nearly 2 million subscribers on youtube to his views on identity, culture and gender; and Jammidodger, who tells her nearly 1 million youtube subscribers about transition, psychology and life from a personal perspective.

They certainly helped me understand how gender dysphoria and transition are experienced by these individuals, and why the pushback against gender ideology resonates so strongly with them. Indeed, their focus is largely introspective, about their own experiences and frustrations, which contrasts with my choice of resources which examine the impact of gender ideology on women as a class and vulnerable people as groups. The apparent preoccupation of people with gender issues with their own situation is striking and, indeed, I wonder whether it is symptomatic.

The videos I watched didn’t persuade me that humans can change sex, nor did they answer the questions that concern me most: the quality of the clinical evidence, the long-term outcomes of medical intervention, or the consequences for women’s rights, safeguarding and healthcare. They deepened my understanding of people’s experiences, but they didn’t change my view that gender interventions come with medical harm to the individual and to safeguarding and women’s rights to privacy, safety and dignity.

If I was to try and create a Peaking Protocol I’d widen the material beyond video:

• A personal narrative or documentary.

• A commentary or philosophical piece.

• A peer-reviewed scientific paper or systematic review.

and then discuss:

• What did you learn?

• Did anything change your mind?

• Which arguments are unconvincing, and why?

I’ve become a bit pre-occupied with thinking what resources might be useful for people who are just on their first Jenga wobble. I did think that I have an open mind, I have said for years that I want to be wrong about gender, that the best outcome is to discover that I have misunderstood something fundamental and am, in fact, a bigoted idot who needed education. Such an outcome would do harm to me, but would mean that those who transition are not at risk, and that would be a good thing.

I have become rather evangelical when I find someone who agrees that sex matters. I have an emotional response to finding someone who “gets it”, and I should probably spend some time reflecting on why that might be. Regardless, I’m looking forward to speaking to my young relative more, things seem much more difficult for people in their 20s because in many circles it is heretical to say that sex matters more than gender.

My youngster has taken a risk in sharing their new perspective with me, and may well change their mind, but I hope not. Few do - is there even an antonym for peaking? Perhaps “troughing” has geographical symmetry, though maybe that is a flawed concept because we really don’t need another word describing something that doesn’t exist.

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I’m trying to get the hang of substack, I’ve been very lazy with working out notes and comments - and ohmaigawsh you can do video on here too? I’ve got to get my book proposal finished and submitted - and then I’ll get onto trying to figure this app out. Is it an app? Is it a site? Who knows, it’s a good place for sharing ideas and practical things for people with pelvic health issues, whether that is due to gender or not.

Here is the reference list accompanying the state-of-the-art review I have collaborated with Professor Ruth Parry, which is about to undergo peer review. We are publishing it to share the evidence discussed in our conference presentation at “Rethinking Youth Gender Medicine” and to provide access the original sources. Here is Nick Wallis’ write up of the presentation, and this is what I wrote about it.

As the paper goes through peer review, references may change, I’ll update this page accordingly.

This reference list accompanies our presentation at the CAN-SG and SEGM conference. You can also read the accompanying conference summary on this post.

We hope making the reference list openly available is helpful to clinicians, researchers, students and anyone wishing to read the evidence for themselves.

The references are alphabetised by first author. Formatting is inconsistent at present (journal titles, punctuation, abbreviations and citation style) and will be standardised to meet the journal's requirements before manuscript submission.

Many thanks to my lead author and friend, Professor Ruth Parry for her hard work on this. I’m learning a LOT from her!

QR code coming. And some intense muttering, I expect.

Thank you for the interest in our work.

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Reference List

ACOG Committee. Caring for Patients Who Have Experienced Trauma: ACOG Committee Opinion, Number 825. Obstetrics and Gynecology 2021; 137: E94–E99.

Albarqouni L, Sanders S, Clark J, et al. Self-Management for Men With Lower Urinary Tract Symptoms: A Systematic Review and Meta-Analysis. Ann Fam Med 2021; 19: 157.

Anllo L. Challenges of Sexual Life after Detransition: Trauma, Disenfranchized Grief, and Unmet Needs. J Sex Marital Ther 2025; 51: 639–651.

Barry ES, Merkebu J, Varpio L. How to Conduct a State-of-the-Art Literature Review. J Grad Med Educ 2022; 14. DOI: 10.4300/JGME-D-22-00704.1.

Barry ES, Merkebu J, Varpio L. Understanding State-of-the-Art Literature Reviews. J Grad Med Educ 2022; 14. DOI: 10.4300/JGME-D-22-00705.1.

Barry ES, Merkebu J, Varpio L. State-of-the-art literature review methodology: A six-step approach for knowledge synthesis. Perspect Med Educ 2022; 11. DOI: 10.1007/s40037-022-00725-9.

Campbell PG, Malone J, Yadla S, et al. Comparison of ICD-9-based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting. J Neurosurg Spine 2011; 14: 16–22.

Cortés-Amador S, Vidal-Chaparro A, Hernández-Guillén D, et al. An overview of the transgender population’s knowledge of the role of physical therapy during the transitioning process: a cross-sectional survey study. Eur J Obstet Gynecol Reprod Biol 2026; 318: 114905.

da Silva LMB, Freire SND, Moretti E, et al. Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study. Int Urogynecol J 2024; 35: 1077–1084.

de Brouwer IJ, Elaut E, Becker-Hebly I, et al. Aftercare Needs Following Gender-Affirming Surgeries: Findings From the ENIGI Multicenter European Follow-Up Study. J Sex Med 2021; 18: 1921–1932.

Ding C, Khondker A, Goldenberg MG, et al. Urinary complications after penile inversion vaginoplasty in transgender women: Systematic review and meta-analysis. Can Urol Assoc J 2023; 14. DOI: 10.5489/CUAJ.8108.

Dominoni M, Scatigno AL, Pasquali MF, et al. Pelvic floor and sexual dysfunctions after genital gender-affirming surgery: a systematic review and meta-analysis. J Sex Med 2025; 22: 184–195.

Ferrando CA, Mishra K, Grimstad FW, et al. A randomized trial comparing perioperative pelvic floor physical therapy to current standard of care in transgender women undergoing vaginoplasty for gender affirmation: the FLOWER Trial. Int Urogynecol J 2023; 34: 2985–2993.

Harrison R, Jones B, Gardener P, et al. Quality assessment with diverse studies (QuADS): an appraisal tool for methodological and reporting quality in systematic reviews of mixed- or multi-method studies. BMC Health Serv Res 2021; 21: 144.

Hatanaka LM de SS, Pereira GMV, Lara LA da S, et al. Pelvic Floor Dysfunction in the Transgender Patient: A Scoping Review. Int Urogynecol J 2025; 36: 2145–2167.

Jorge CH, Bø K, Chiazuto Catai C, et al. Pelvic floor muscle training as treatment for female sexual dysfunction: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 231: 51–66.e1.

Liang S, Li J, Chen Z, et al. Prevalence and Influencing Factors of Help-Seeking Behavior Among Women with Urinary Incontinence: A Systematic Review and Meta-Analysis. J Womens Health 2023; 32: 1363–1379.

Loving S, Nordling J, Jaszczak P, et al. Does evidence support physiotherapy management of adult female chronic pelvic pain? A systematic review. Scand J Pain 2012; 3: 70–81.

Manrique OJ, Adabi K, Huang TCT, et al. Assessment of pelvic floor anatomy for male-to-female vaginoplasty and the role of physical therapy on functional and patient-reported outcomes. Ann Plast Surg 2019; 82: 661–666.

Mattawanon N, Charoenkwan K, Tangpricha V. Sexual Dysfunction in Transgender People: A Systematic Review. Urol Clin North Am 2021; 48: 437–460.

McIntosh S, Harries B, Perry M, et al. Barriers & Facilitators to Help-Seeking Behaviour for Abnormal Lower Urinary Tract Symptoms in Men: Systematic Review. Cancer Med 2025; 14: e71214.

McLellan C, Yeh PT, Kennedy CE, et al. Global Burden of Violence Against Transgender and Gender-Diverse Adults: A Systematic Review and Meta-Analysis. JAMA Netw Open 2026; 9: e2552953.

Miroshnychenko A, Ibrahim S, Roldan Y, et al. Gender affirming hormone therapy for individuals with gender dysphoria aged <26 years: a systematic review and meta-analysis. Arch Dis Child 2025; 110: e327921.

Moreira ED, Glasser DB, Nicolosi A, et al. Sexual problems and help-seeking behaviour in adults in the United Kingdom and continental Europe. BJU Int 2008; 101: 1005–1011.

Myers C, Smith M. Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: a systematic review. Physiotherapy 2019; 105: 235–243.

National Guideline Alliance (UK). Pelvic floor muscle training for the management of symptoms: Evidence Review (NICE Guideline No. 210). National Institute for Health and Care Excellence (NICE), December 2021.

Ortengren CD, Blasdel G, Damiano EA, et al. Urethral outcomes in metoidioplasty and phalloplasty gender affirming surgery (MaPGAS) and vaginectomy: a systematic review. Transl Androl Urol 2022; 11: 1762–1770.

Phillips A, Stiller K, Williams M, et al. Medical Record Documentation: The Quality of Physiotherapy Entries. Internet Journal of Allied Health Sciences and Practice 2006; 4: 4.

Ray A, Fernstrum A, Mahran A, et al. MP30-20 Lower Urinary Tract Symptoms in Transgender Persons Treated With Estrogens. J Urol 2020; 203. DOI: 10.1097/JU.0000000000000869.020.

Tordoff DM, Lunn MR, Chen B, et al. Testosterone use and sexual function among transgender men and gender diverse people assigned female at birth. Am J Obstet Gynecol 2023; 229: 669.e1–669.e17.

van Vugt WLJ, van den Boogaard E, van der Tuuk K, et al. Gynecologic function and dysfunction in transmasculine and gender-diverse individuals using testosterone therapy: a systematic review. Am J Obstet Gynecol. Epub ahead of print February 5, 2026. DOI: 10.1016/J.AJOG.2026.01.036.

Waljee J, McGlinn EP, Sears ED, et al. Patient expectations and patient-reported outcomes in surgery: A systematic review. Surgery 2014; 155: 799–808.

Waterschoot M, Hoebeke P, Verla W, et al. Urethral Complications After Metoidioplasty for Genital Gender Affirming Surgery. J Sex Med 2021; 18: 1271–1279.

Widenor RCL, Hofmann MC. Indications for the Utilization of Pelvic Floor Physical Therapy for Transgender Women Following Gender-Affirming Vaginoplasty: A Narrative Review. Transgender Health. Epub ahead of print June 4, 2025. DOI: 10.1089/TRGH.2021.0159.

Yaish I, Amir H, Eilam H, et al. Effects of gender-affirming hormone therapy on lower urinary tract symptoms and sexual function among transgender individuals. Int J Gynecol Obstet 2025; 168: 1292–1297.

This page will be updated with the full citation and a link to the published paper once the manuscript has been accepted and published.

Sheesh, being an anti-rights activist takes up rather more of your sunny Sunday than you bargain for!

Complaint - A Growing Threat - The Anti-Rights Movement in the UK

Dear Ms Moscogiuri, Ms Horton and Mr Ruthven,

I am writing in response to Amnesty UK’s report A Growing Threat - The Anti-Rights Movement in the UK, in which Scot PAG is characterised as part of an “anti-rights” movement.

As the founder of Scot PAG and as a registrant of the Health and Care Professions Council, I am concerned by your characterisation and its professional and personal consequences.

The report reaches conclusions about Scot PAG that I simply do not recognise from our published work.

My work as a pelvic health physiotherapist increasingly involves supporting trans-identifying people experiencing unwanted effects or complications of gender-related medical and surgical interventions. By publicly associating me with an “anti-rights” movement, Amnesty UK has created a real risk of undermining my ability to form a therapeutic relationship with a patient before I have even met them.

I am also concerned about the wider consequences for patient care. It is already difficult to recruit clinicians into this field. Many healthcare professionals are understandably anxious about complaints arising from perceived offence or disagreement over language, and consequently avoid working with this patient group altogether. Publicly characterising clinicians who do undertake this work as “anti-rights” risks making that problem worse. In my view, that outcome would ultimately disadvantage the very people your report is seeking to protect.

Your report also has implications for research, collaboration and public engagement. I hope to seek funding to investigate the long-term pelvic health consequences of gender-related medical interventions because dedicated rehabilitation services for this patient group are currently almost non-existent. I cannot know what influence, if any, this report may have on future collaborators or funding bodies. Having a globally recognised human rights organisation publicly characterise my professional group in this way may affect how our work is perceived before it is evaluated on its merits.

Over recent years I have been subjected to abuse and threats of violence because of my publicly expressed view that biological sex is real and, in healthcare, sometimes clinically relevant. I therefore take seriously the potential consequences of Amnesty publicly applying morally loaded labels that may encourage others to misunderstand my work, my motivations and my professional ethics.

I was particularly disappointed that Amnesty UK did not seek to engage with me or Scot PAG before publishing these conclusions. An email asking about our objectives, activities or the evidence underpinning our work would have been both straightforward and consistent with the standards of fairness that I have long associated with Amnesty UK.

I therefore ask Amnesty UK to explain the evidential basis upon which it concluded that Scot PAG - and, by implication, me as its founder - should properly be characterised as part of an “anti-rights” movement. Please identify the evidence relied upon and the methodology used to reach that conclusion.

I have submitted a Subject Access Request seeking disclosure of any personal data held by Amnesty UK relating to me. Once I have considered your response to both this letter and my SAR, I will decide what, if any, further steps are appropriate.

I look forward to your reply.

Yours sincerely,

Elaine Miller
Fellow of the Chartered Society of Physiotherapy
Founder, Scot PAG

Data Protection Officer, dataprotection@amnesty.org.uk

Dear Sir or Madam,

Subject Access Request

I write to request access to my personal data under Article 15 of the UK General Data Protection Regulation.

Please provide a copy of all personal data held by Amnesty UK relating to me, whether held electronically or in paper form.

This request includes personal data contained in, but not limited to:

• emails;

• instant messaging platforms (including WhatsApp, Signal, Microsoft Teams and Slack where used for Amnesty UK business);

• meeting notes and minutes;

• draft reports and supporting documents;

• internal correspondence;

• databases and CRM systems;

• handwritten notes; and

• any other records in which I am identified or identifiable.

This request includes all personal data relating to me processed during the preparation, review and publication of the report A Growing Threat - The Anti-Rights Movement in the UK. This includes, but is not limited to, any opinions, assessments, characterisations, draft wording, internal discussions, evidential assessments, source material and correspondence relating to me or referring to me.

In accordance with Article 15 UK GDPR, please also provide:

• the purposes for which my personal data are processed;

• the categories of personal data concerned;

• the recipients, or categories of recipients, to whom my personal data have been disclosed;

• where my personal data were not obtained directly from me, the source of those data;

• the envisaged retention period, where possible; and

• information about any automated decision-making or profiling, if applicable.

Where personal data have been withheld or redacted because they relate to another identifiable individual, please identify the legal basis relied upon for that decision.

If you require clarification please let me know as soon as possible.

I look forward to receiving your response within the statutory time limit.

Yours faithfully,

Elaine Miller

Fellow of the Chartered Society of Physiotherapy

And this is ScotPAG’s - it’s signed by our members but I removed the names because some people are, understandably, concerned about being discussed in the public sphere like this.

Thank you to my colleagues at Scot PAG and the many other people who have written, “Amnesty UK twitter” has been busy today!

To quote Lucy Hunter Blackburn - “this isn’t over yet”.

Tomorrow I REALLY need to get my book proposal finished and tidy up some admin I have neglected from CAN SG. If you catch me on twitter please tell me off!

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On its 50th anniversary Amnesty said that “the famous Amnesty International candle wrapped in barbed wire was inspired by the ancient Chinese proverb; ‘It is better to light a candle than to curse the darkness’.”

Amnesty has now released a report characterising 51 organisations, including Scot PAG, a group I founded in 2022, as part of an “anti-rights movement”.

The report has been removed, but Wings Over Scotland had archived it, so if you click on that link you can read it. Thanks, Rev.

The report describes an “organised backlash against trans people’s rights” and a “growing movement against the rights of women and LGBTI people in the UK”. It goes on to state that 51 organisations “all share broadly the same goals and appear to closely collaborate and endorse one another”. Later it says that “anti-rights actors seek a society in which women and men have fixed and distinct roles” and perceive the idea that gender is socially constructed as a threat.

I don’t recognise my group, or myself, in those claims.

The report points to organisations signing the same letters, attending the same events, speaking on one another’s platforms and, in some cases, having overlapping memberships. Those things certainly demonstrate contact but do not, by themselves, demonstrate that 51 organisations with very different purposes all share the same goals. Scot PAG is a professional group, Beira’s Place is a rape support service, Virago Women’s Workshop supports women, LGB Alliance campaigns on the rights of same sex attracted people, Sex Matters is a human rights charity, MBM are policy analysts and For Women Scotland campaigns for women’s rights in Scotland, a side impact of which is keeping the Supreme Court in gainful employment. If Amnesty is going to characterise us all as part of the same “anti-rights” movement, I think it should show its workings.

What Amnesty has done, in my opinion, is reduce itself to something almost Abigail-esque: pointing wildly at organisations working in a similar area, and declaring them part of an “anti-rights” movement without evidence proportionate to the seriousness of the allegation. Once named, the burden shifts to eg “Goodie Scot PAG” to prove she is not a heretic.

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Amnesty’s little yellow candle symbolises courage in the face of injustice. I reckon it can multi-task and light the pyre beneath the reputations of the hundreds of people associated with the 51 organisations it has chosen to denounce.

Scot PAG a small group of Scottish clinicians, educationalists and social workers who are concerned about the quality of evidence supporting gender interventions and the consequences those interventions have for individuals, organisations and systems. They are a very smart group, who work hard and have been a source of wisdom for me personally. I am proud to know them.

We are another little group of people who have no time, money or funding, despite which, have met with MSPs and MPs, contributed to consultations, taken part in stakeholder groups and round-table discussions, and tried to be useful.

However - by being added to this list of, in my view, heretics, Amnesty have damaged our ability to do that.

Imagine you are one of our new cohort of MSPs. ScotPAG, or a member of Scot PAG, asks to meet you and, as you prepare for the meeting you discover the group has been characterised as part of an “anti-rights” movement by Amnesty UK.

What picture do you form in your mind? What assumptions are you likely to make before you’ve read a single word of our submission? Will you still meet with us? Will you be able to judge our suggestions on their merits?

Words like “anti-rights” carry enormous weight. They are not merely descriptions of policy disagreement. They suggest opposition to the rights and dignity of other people.

If a young person reads that the clinician treating them belongs to an “anti-rights” group, what effect does that have on the therapeutic relationship? If a colleague or employer reads it, does it influence your appraisal? Supposing we wanted to apply to the Wellcome Trust for a grant and they see this, does it matter? Labels attached by globally recognised organisations have a habit of travelling quite far. After all, we all know there is no smoke without fire beneath the pyre, and just look at who laid that kindling…

I’ve been called all sorts of things over the years. One of my favourites was a colleague who foolishly put in writing “If she is capable of that...” (referring to the time I didn’t flash the Scottish Parliament) “...she is capable of ANYTHING.” which I found rather buoying and have kept it in mind ever since. Her grumble was uncovered by an Subject Access Request and showed me that, if I wanted to, I could “go girl”, “reach for the stars”, “run the world” or whatever it is that women who believe in themselves are supposed to do.

This report, produced by one of the world’s best-known human rights organisations, doesn’t simply say it disagrees with us. It attributes to us goals and motivations that I simply do not recognise in Scot PAG’s or in my own work.

I have read those sentences several times and can only conclude that Abigail Amnesty did absolutely no reading about and has no insight into the organisations it accuses. Robust disagreement is part of professional life, but Amnesty UK did not approach ScotPAG for a chat. I don’t know if they spoke to the other 50 organisations or just went straight to moral classification.

If I make a public statement I am expected to be able to support it with evidence. If I publish research, I am expected to share my methodology. If I make a serious allegation, I am expected to justify it.

I don’t think Amnesty should be held to a lower standard.

‘It is better to light a candle than to curse the darkness’

Happily, this isn’t the first time someone tried to burn this particular witch. Indeed, I’m beginning to believe that I’m made of asbestos.

Now, who wants that on a t-shirt?

(Scroll down for SAR info, you might need it)

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I should make it clear that the above is my own view and not that of Scot PAG, who will be writing a joint letter to Amnesty. I’ll write a much less tactful version about myself.

I shall also submit a Subject Access Request to see what, if any, data they hold on me as an individual. If you are linked with any of the other organisations (the record so far is one woman who’s in three) then I suggest you do the same.

Draft SAR is below (caveat, I Am Not A Lawyer) and it should be sent by post to:

Data Protection Manager, 2nd Floor, Peter Benenson House, 1 Easton Street, London, WC1X 0DW

Or by email: dataprotection@amnesty.org.uk

[Your Name]
[Address]
[Email]

[Date]

Data Protection Officer
Amnesty International UK

Dear Sir or Madam,

Subject Access Request: Article 15 UK GDPR

I write to request access to my personal data under Article 15 UK GDPR.

Please provide a copy of all personal data held by Amnesty International UK relating to me, including personal data processed in connection with my role as [position] of [organisation].

This request includes, but is not limited to, personal data contained in emails, instant messaging platforms (including WhatsApp, Signal, Microsoft Teams and Slack where used for Amnesty business), meeting notes, reports, draft reports, internal correspondence, databases, and any other records in which I am identified or identifiable.

It also includes any opinions, assessments, characterisations or evaluations relating to me, including any personal data processed in connection with the report A Growing Threat – the Anti-Rights Movement in the UK.

In accordance with Article 15 UK GDPR, please also provide:

- the purposes for which my personal data are processed;

- the categories of personal data concerned;

- the recipients or categories of recipients to whom my personal data have been disclosed;

- where my personal data were not obtained directly from me, the source of those data; and

- the envisaged retention period, where possible.

If you require any further information to identify my records, please let me know as soon as possible.

I look forward to your response within the statutory time limit.

Yours faithfully,

[Name]

Physiotherapists are not philosophers. We are trained to analyse anatomy, form and function, not ideology.

I spend most of my working day thinking about bladders, bowels, painful sex and movement. Assessing someone with a pelvic health condition means answering things like:

• What has this person stopped doing because of their condition?

• Can they sit comfortably?

• Does their bladder or pain disturb their sleep?

• Does their condition interfere with their relationships?

• Can they get back to living their life?

Increasingly, though, my reflective practice keeps returning to one question:

What the hell have we doing?

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Last week I attended the joint conference of the Clinical Advisory Network on Sex and Gender (CAN-SG) and the Society for Evidence-Based Gender Medicine (SEGM) in London, hoping that some of the answers might become clearer.

The conference brought together clinicians, academics, researchers, surgeons, whistleblowers, journalists, parents, detransitioners and activists. Over two days I heard presentations spanning paediatrics, psychotherapy, psychiatry, ethics, primary care, surgery, neurodiversity and rehabilitation. It was an extraordinary concentration of expertise, and it was emotionally draining.

I’m up to speed with the evidence in this, rather barren, field, but hearing story after story, presentation after presentation, over the course of two days was surprisingly wearing.

A friend texted to ask how it was going.

“It’s great, but I’ve twice gone to the loo for a bubble.”

Apparently “bubble” is not English, but Scots vernacular for “weep”. My English friend briefly thought I’d taken to hiding in the toilets to drink fizzy wine and was preparing an intervention. Which was very kind of her.

Almost every session described harms that should have been prevented, complications that should have been anticipated, or patients and families struggling to find anyone willing - or able - to help them.

Meeting so many people who had lived through gender services themselves, parents trying to support sons and daughters through extraordinarily difficult circumstances, and clinicians determined to improve the lot of these individuals was inspiring.

Again and again I heard the same message: when healthcare had nothing to offer them, they found and supported each other.

Their peer support networks are remarkably organised, compassionate and knowledgeable. But they exist because, in many cases, there was nowhere else to go.

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My contribution

I presented the first findings from a review Professor Ruth Parry and I have been undertaking into urinary, sexual and pelvic health outcomes following transgender-related hormonal and surgical interventions, and whether physiotherapy has a role in helping people experiencing unwanted effects.

The review asks three simple questions.

• How common are these problems?

• Does physiotherapy help?

• What should happen next?

Pelvic health physiotherapists routinely treat continence problems, pelvic pain and sexual dysfunction, and we are very good at it. Multiple Cochrane Reviews support that.

We think physiotherapy can be helpful in gender interventions because they do not create entirely new challenges. We already rehabilitate people after radical cancer surgery, major trauma and complex orthopaedic procedures. The principles are the same, personal identity doesn’t change physiology.

Surely these people deserve the same standard of care as everyone else? If so, why do I have evidence of pelvic health services refusing referrals because “we don’t deal with gender”?

My Heath Robinson infographics summarising the findings from our (as yet unpublished) review are above, and below, and Nick Wallis reported on my presentation here.

The next step

Ruth and I are now preparing the paper for peer review. Like everyone involved in this project, we work voluntarily. Our lived-experience contributors generously gave their time and trusted us with deeply personal experiences. They challenged our assumptions, improved our recommendations and made the paper immeasurably stronger. Our peer reviewers will also donate their expertise.

The only part of the process that isn’t free is making the evidence available to everyone. Publishing the paper as open access - so that clinicians, patients and families can read it without needing an expensive journal subscription - will cost around £5,000.

Normally these fees are covered by research grants or university funding. Work that challenges current practice often finds that support rather harder to come by. It is striking that work which supports the convention that gender interventions are always positive gets central funding and lashings of it.

Nevertheless, we think open access matters. Research that has the potential to improve patient care should be available to the people who need it. The Bright Club has a long history of academics disseminating their research through stand up, so maybe comedy shows could sort our funding issue. Realistically, we need to produce and publish a series of high quality but small studies to make ourselves eligible for proper funding. A study that gathers and analyses empirical data needs a host university or NHS Trust, a research fellow, a clinical supervisor and ethics - which needs hundreds of thousands of pounds. We all know that “shy bairns get nowt”, so we’ll give it a go.

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Where next?

I think physiotherapy - and all Allied Health Professions - urgently need to develop expertise in this area.

An unknown number of people are living with unwanted effects of hormonal and surgical interventions, alongside a growing number of detransitioners. At present there are no dedicated rehabilitation services for them.

Long-term, complex conditions are bread and butter for rehabilitation professionals. I suspect we will work closely with primary care because many people with negative outcomes make it clear they have no wish to return to gender clinics.

The first challenge will be finding colleagues willing to address negative outcomes of gender interventions. Speaking publicly about these issues is not easy.

My own professional body has around 67,000 members. As far as I can tell, I am the only one currently speaking publicly about this aspect of care. Statistically, that seems improbable and I suspect the silence tells its own story.

Professor Ruth Parry and I are therefore exploring the creation of a support network for Allied Health Professionals, operating alongside organisations such as Biology in Medicine and SEEN in Health. The aim would be mutual support, collaboration, research and, ultimately, better training so we can deliver better care.

If you are an AHP and think you would find such a network useful, or would like to help develop it, please do get in touch.

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Leaving the conference

What struck me most over those two days was not the hostility outside, but compassion inside. Attendees had nothing but concern for people whose lives have become more difficult following gender interventions, regardless of whether they continue to identify as trans or have detransitioned.

It is peculiar to me that the people expressing such concerns are characterised as being motivated by hatred. My impression is firmly the opposite, anyone speaking up wants the same thing: honest evidence, thoughtful discussion, legal protections and healthcare that helps people live the fullest lives possible.

For me, refusing to acknowledge that people with unwanted outcomes from these interventions exist, ignoring their symptoms, or denying them treatment because of assumptions about their gender identity is incompatible with compassionate healthcare, and uncomfortably compatible with transphobia.

I’m enormously grateful to the individuals who trusted Ruth and me with their experiences and helped shape our work. Their generosity will, I hope, improve care for people who come after them.

Thank you to CAN-SG and SEGM for hosting such a thoughtful conference and for giving us the opportunity to present our work. And to Nick Wallis who covered my talk.

There is plenty to be getting on with. I’m encouraged to see that the right people to answer my earlier question of “what the hell have we allowed?” just keep on finding each other. It’s heartening.

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WRN Afghanistan recently asked me if I would talk to some of the women they work with about menstruation. I hesitated, I’m not a gynaecologist, and I am mindful of my scope of practice: what if they asked questions I wasn’t qualified to answer? After half a thought, I realised that “see a doctor” might be unrealistic in modern-day Afghanistan anyway. The women had asked for practical information, and that is something I can give.

Afghan women living in cities may be able to access healthcare through hospitals, clinics or pharmacies, inevitably, in rural areas, it can be much more difficult. Transport may be expensive or unsafe, and regime rules mean women may be unable to travel without a male relative. There is a long-standing national shortage of female health professionals which is unlikely to be resolved anytime soon until the education of women and girls resumes.

WRN Afghanistan works hard to keep the lives, rights and voices of Afghan women and girls in public view. Their request is simple:

“Don’t forget Afghan women”

They have links with women across the country and work together to provide internet access, education resources, poetry workshops, and menstruation packs. I can’t fathom how they are managing to do it under such a dangerous regime, the only sensible conclusion is that “sisterhood is powerful.”

You can read the words of Afghan women on the WRN site. This is one woman’s summary of the changes imposed on her life:

Things I can no longer do

I can’t go outside alone without a male relative from my home.

I can’t go to school over the age of 12.

I can’t go to university or the gym or park.

I can’t be an engineer or pilot or singer or athlete.

I can’t go work, except as doctors or nurses in some hospitals.

I can’t go to male doctors for treatment.

I can’t deal with male shopkeepers.

I should wear a long burqa which covers me from head to toe.

I can’t talk or shake hands with non-mahram (close family or spouse) males.

I can’t laugh loudly. (No stranger should hear a woman’s voice).

I can’t ride in a taxi without a mahram.

I can’t present or speak in radio, television or public gatherings. But if I did I would have to cover my face during any TV program.

I can’t play sports or enter a sports center or club.

I can’t ride bicycles or motorcycles, even with a mahram.

I am banned from listening to music – this applies not only to women, but men as well.

There is a ban on male tailors taking women’s measurements or sewing women’s clothes.

She goes on to say they must not be perfumed, adorned, or make a sound, including laughter. That brings me up short every time that I think about it, the one thing I have thrived on during the last few baffling years is the joy of a good cackle with other women. The thought of being denied that is, well, incomprehensible. I understand it, of course, it’s nearly 45 years since Margaret Atwood’s stark observation:

Men are afraid women will laugh at them. Woman are afraid that men will kill them.

Shared humour is a powerful shortcut to communication. Laughter tells us that another person has seen what we have seen, we have understood the same absurdity - and if that absurdity is an injustice then the shared laugh tells us we are not isolated. Sharing a joke creates an instant bond. I can see why oppressive regimes and insecure men don’t much like the idea of women laughing.

So, of course, I was going to grab the chance to speak with women living in Afghanistan, and I set about writing a talk that would fit into one precious hour of internet connection. I have given inservice training to physiotherapists in countries with limited infrastructure, I can adjust my accent for a translator and pause while a fuzzy internet connection catches up. I have “met” some fantastic people doing extraordinary work with almost no resources, people who are genuinely hashtag-inspirational.

I was grateful for a quick chat with S, about what women in Afghanistan commonly hear about menstruation: menstrual blood is dirty and shameful, and menstruating women are unclean. Girls are often discouraged from talking about periods, and many know nothing about menstruation until their first bleed. Period pain may be seen as something to endure, while painkillers or particular foods are said to affect the next month’s period. Some women may also be told that having or missing a period means they have sinned or are being punished.

So far, so standard, the shame and stigma surrounding the normal things that women’s bodies do is pretty much universal and timeless.

I wanted to ask more. Are there sanitary-product manufacturers in Afghanistan? Cotton is grown there as a cash crop, so perhaps the country is not entirely reliant on imports. And what, I wondered, does the regime make of a truckload of menstrual pads? I have no idea.

I had my trusty pelvic model, a pear to show the size of the uterus, two dates to represent the ovaries, an egg to show roughly how much blood is lost during a period, and samples of washable pads and period pants. I also had peace and quiet, because the rest of the household was having a long lie-in after staying up until 4 a.m. to watch Scotland play a lucky game of football in the World Cup.

The women logged on and behind each little black square sat a woman whose life was wildly different from my own. Their screens were all off and most had anonymised names, for their safety. I was grateful for S’s fantastic translation skills, but more of the group had English than I expected. Certainly all of them have more English than my Dari which is limited to “lotfan” and “tashakur”, hastily learned from Google translate.

One of the things I wanted them to know about ovaries is that the egg that would eventually become each of us was already present in our mother’s ovary while she was developing inside our grandmother’s uterus. Three generations of women were physically connected. It is such a lovely fact, and it blows my mind. My canva skills are rudimentary but I managed to adapt online images and cobbled this together:

I’ve drafted a booklet of information for the women. They want to be able to talk to other women and girls around them so that more of them can understand their menstrual cycles. I included basic self-management for cramps and constipation, along with tips and a pattern for hand-sewn washable pads.

One of the questions was:

“I was told that getting married would reduce menstrual cramps, is that true?”

I replied:

“Well, I don’t know what the men are like in Afghanistan, but I have yet to meet one here who is magical. So, I’m sorry to say, no”.

The women laughed, lots of little emojis and hearts floated up over my screen of black squares, and so, we laughed together.

Regina Barreca wrote “laughing together is as close as you can get to another person without touching, and sometimes it represents a closer tie than touching ever could.”

In that moment, despite the vast distance and differences of our lives, that was exactly how it felt. And, oh my goodness, that was joyous.

Thank you, WRN Afghanistan for what you do and for giving me a lovely Sunday morning.

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Women in Afghanistan need organisations that continue to pay attention while the rest of the world gets distracted by football, politics and all of the life that gets in the way.

If you’d like to support the work of WRN Afghanistan you can donate funds for their internet access or to Victory Afghanistan. Time is a gift too, volunteers welcome.

Thank you to WRN Afghanistan for the chance to “meet” wonderful women, with whom I hope to laugh again.

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Good guide to sewing your own pads

Decent podcast from the BBC, they are a bit shy of using the word “woman” but the information is solid. Lots of women start listening on day 1 of their bleed, each day tells you what is happening in your body. 28ish Days Later

WRN draft letter to your MP

There are signs that the tide is turning on gender ideology, and we may yet see women’s legal rights to privacy, safety and dignity properly upheld in the UK. However, the clinical issues remain in need of some attention.

We don’t know how many people have gone through gender interventions, and are not collecting data on how they are doing. We know next to nothing about those who have demedicalised, detransitioned or desisted.

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I do think gender interventions in their current form will, eventually, stop - but many people will be left living with the consequences of hormones and surgery.

In 20 years society will probably view bearded women with mobility aids as victims of flawed medical advice. We have seen this before, we used to see people around who had visible signs of being injured by thalidomide. You knew that person’s mother followed medical advice she trusted, the consequences of which changed the family’s lives forever.

Most will now be in their 60s, and I don’t see many people with thalidomide injuries around any more. Thalidomide survivors often live with pain, fatigue and reduced mobility, and many need rehabilitation and support. Those needs could not be anticipated when they were born.

I expect the long-term physical consequences of gender interventions will be similar. A population with complex, long-term health needs was created, and we should be planning the services they will require.

So, what harms from gender care am I talking about? There are many gaps in the evidence base for efficacy, but the data on unintended physical effects should be seen as more hole than colander. Patterns are emerging, but they are not well described, not systematically collected, and not translated into clinical guidance.

We know that people who take cross sex hormones report shared experiences of pain, weight gain and, in females, vaginal atrophy. The clinics seem to avoid these issues, and the people with them are reluctant to talk about them because saying anything negative about transition can get you shunned by the community. It seems to me that the “be kind” community isn’t very compassionate or supportive.

Without good data we cannot determine need, and without determining need we cannot build a safe, effective clinical service.

Consider a female person who would not thank me for calling her a woman. She starts testosterone at 18 in an attempt to manage distress. Taking testosterone in large doses suppresses ovarian function, and her body enters a low-oestrogen state, similar to menopause, decades earlier than the average age of around 51.

If a woman under 45 becomes menopausal, the care pathway recommends she be offered HRT because loss of oestrogen affects bone, cardiovascular and brain health. That guidance exists because we have data, understand the risks, and can therefore plan for them.

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What we do not know is what happens when that endocrine disruption begins at 18. There is no robust, longitudinal data examining what happens to bone density, cardiovascular health, mental health or, indeed, anything else if normal endocrine function is disrupted early in life. But we know enough about the consequences of oestrogen loss to routinely offer HRT to women 25 years older, so it is reasonable to assume that whatever happens is unlikely to be brilliant.

Pelvic pain, incontinence and sexual dysfunction are commonly reported, yet there are no guidelines for GPs or pelvic health physiotherapists to follow. Anecdotally, lots of these people also complain of reduced mobility, exercise intolerance, genital pain, joint pain and muscle pain, which are barely described in the literature.

The gap is even wider for people who stop using cross sex hormones. We know almost nothing about what changes after stopping hormones, or what common complications persist after surgical interventions.

There is an established need for shoulder care after single mastectomy for cancer, so why is there no equivalent pathway to prevent shoulder dysfunction for those who have had a double mastectomy in an attempt to manage gender distress? Why are we not following these people up? A stiff, painful shoulder is surprisingly disabling, people should not be expected to put up with it, never mind two.

Physiotherapy routinely contributes to the management of cardiovascular disease such as stroke and heart disease, mental health conditions, obesity, osteoporosis, musculoskeletal disorders and pelvic health. We are used to managing complexity caused by accident or neurological conditions. We can use our bread-and-butter skills to piece together support for issues related to gender, but we first need to establish what people are experiencing, how it is affecting their function, what help they have been offered and what is missing. However, it seems that either no one thinks it is their job, or they are too afraid to take it on.

Afraid? Yes, the workforce is nervous. If clinicians cannot state basic biological facts without being accused of prejudice, they will not want to work in this field. Much has been made politically of the appalling waiting lists for gender services, but there has been little analysis of there is a recruitment and retention problem.

My view is that working in an area where evidence is weak, guidance is absent, and open discussion is constrained and carries the risk of disciplinary action is not very appealing.

All of which means there are people living with debilitating physical and mental symptoms who have no clear pathway to help. There are potentially tens of thousands of people with unmet clinical needs.

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I am presenting work I co-authored with Professor Ruth Parry on physiotherapy approaches to managing the health impacts of gender interventions at CAN SG in July. If you can make it along to the conference then please do, especially if you disagree with everything I have said - debate is how excellence is established.

I’ve got a small multidisciplinary group looking at how we can establish unmet need more systematically. If you’d like to be involved let me know.

If no one thinks this is their job then maybe I’ll have to make it mine.

Every now and then I meet a woman in clinic who arrives slightly breathless, almost late, juggling bags from which spill out her shopping and emotions. The perma-harried women are also the ones who, once tucked under a blanket on my plinth, naked from the waist down (top tip, keep your socks on, cold feet don’t help you relax) say:

“I’m sorry, I didn’t have time to shave.”

The correct answer to this is always:

“That’s alright. Neither did I.”

It is very important to me that you understand that when clinicians say “we are not judging you” we actually mean it. We peer at your bits to look for pathology, not to rate them out of ten. It’s healthcare, not Pube Idol.

However, clinicians should think about why some women feel that they should not have pubic hair before attending to their health - and the reason for that is because that’s what hospitals taught us.

For much of the twentieth century, basic infection control meant shaving the pubic area on admission to labour ward. All women showing up to a British or American labour ward were “prepped” - shaving was as routine as blood pressure monitoring. It was believed that pubic hair harboured germs, and plenty of them, which is odd because they didn’t remove the hair on labouring women’s heads. Since the 1920s there had been evidence questioning this flawed logic, in the 1970s Doris Haire (actually her name, which is marvellous) showed infection rates were no lower - and in some reports slightly higher - among women who had been shaved, likely from razor’s micro-abrasions. The Boston Women’s Health Collective complained about this in Our Bodies, Ourselves, describing prepping as unnecessary and undignified, and urged women to question it. Thus birth activism was born and hospital policy shifted. It still took until the 1990s for routine perineal shaving to be abandoned.

The cultural expectations still linger, pregnancy forums are full of questions about how best to tidy up when your bump obscures your view. My advice is to get someone to do it for you, and use a tried and tested technique. A good friend of mine tried wax strips for the first time at 36 weeks of labour, and ripping off the first strip brought on labour. Not. Even. Joking.

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Faith, Discipline and Devotion

For millions of women, pubic hair management is an article of faith.

In Islam, regular removal of pubic and underarm hair is part of ritual cleanliness and bodily discipline. There are 1500 year old texts in rabbinic Judaism which discuss the removal female body hair, this pre-dates modern beauty marketing by quite some margin. Conversely, for observant Sikh women, keeping body hair is a core spiritual principle.

What one practice frames as cleanliness another views as respect for divine design, but pubic hair is an important part of many women’s spiritual and cultural life.

Mainstream Minge

In 1987, the seven J Sisters introduced the Brazilian wax to New York women. Janea, Jocely, Juracy, Jussara, Jocasta, Jurema and Judseia Padilha opened a salon in Manhattan, inspired an episode of Sex In The City and a steady stream of women left their spa with a startled expression and a slightly bow-legged walk.

By the early 2000s, mainstream pornography overwhelmingly depicted hairless genitals, and what started as a niche beauty treatment became routine self-care for lots of women and the subject of debate in many feminist circles. The one thing it wasn’t was new.

Grooming did not begin with a gaggle of Brazilian sisters, faith, porn or instagram. I think there’s some evidence that grooming predates agriculture.

Prehistoric Pubes

In 1908 archaeologists unearthed a tiny stone carving of a woman looking down on her glorious body. Her vulva is proud and bald, which is, surely, an artistic choice because the carving of her head hair is detailed enough to show braids or beads. It was assumed that The Venus of Willendorf was some sort of fertility talisman. Of course, few women directed excavations (nowadays about half of early-career archaeology academics are female, which seems to me to be about the right number) The thinking seemed to be “breasts = sexy = fertility” and the question of why this little figurine had no pubic hair was unasked. In 1996 a paper (with a female co-author) hypothesised that these little figurines are self portraits. In pre-IKEA-full-length-mirror-times women looking at their body in the reflection of a shallow pool of water would see a visual distortion that resembled the little Venus - big boobs, belly and thighs but diminished feet and face.

But, a question remains - the two hundred or so prehistoric female figurines found across Europe and the Near East rarely depict pubic hair. Why? Now, I’m no expert - everything I know about archaeology I learned from Indiana Jones - but, is there a question here? Either they represent young, fertile women who removed their hair, or these little statues are venerations of older women. Pubic hair patterns change at menopause and it is common for it to thin. Older women would have had the knowledge of how to survive long winters, scarcity and keep babies warm and safe from pre-historic hazards, perhaps crones were so revered they were worth carving in rock.

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Razors and Ritual

It is possible that prehistoric women groomed, 30,000 years ago people used sharpened shells or flint to scrape off facial or body hair. Razors made around 6500 BCE from obsidian were found in Anatolia.

In 473 BCE a 70-year-old woman named Hatnefer was buried in Egypt, with her copper razor. This tells us two things about Hatnefer, she wanted to present herself to the gods with a “pure”, ie hairless body - and she had a very steady hand. Who amongst us with memories of a badly aimed safety razor thinks this looks like a tool for DIY labiaplasty?

The Greeks removed pubic hair by singeing or plucking. Persian women used early depilatory creams. Upper-class Roman women would have enslaved a woman to work as her picatrix, pumicing pubes into shape. In these societies civilisation meant being bare, but even then personal preference varied, in AD70 someone scrawled on a Pompeii brothel wall:

“Hic ego puellas multas futui; sed nullam futui pilosiorem.”

If your latin is limited to “Nolite te bastardes carborundorum” then here’s the translation

“A hairy cunt is fuckd much better than one which is smooth; it holds in the steam and wants cock.”

The debate about to pluck or not to pluck has a long history.

Medieval Chemistry and Witchcraft

Medieval women were not obsessive, but, had opinions about body hair.

Trota of Salerno advised mixing ants’ eggs, red orpiment (arsenic sulphide) and gum of ivy to remove hair. A later beauty manual recommended boiling arsenic and quicklime and washing it off quickly “so the flesh does not come off.” This is where patch tests originated.

Renaissance Smooth, Literary Abundance

Renaissance art idealised smooth female bodies, hairlessness was next to godliness. Botticelli’s Venus emerges hairless below the waist, her modesty covered by her flowing locks and hand. Modesty was meaningful.

At the same time, Welsh poet Gwerful Mechain wrote an ode celebrating women’s genitals which ends with “a girl’s thick grove… lovely bush, God save it.”

During the European witch trials, women were stripped and shaved to search for the “devil’s mark” which could be a mole, a supernumerary nipple or a perfectly ordinary clitoris. It was thought that witches held their power in their hair, removing it was both humiliation and control in a society where modesty mattered for women.

Pubic hair has long been entangled with autonomy and authority in Europe. I’m from Ayrshire in Scotland and, back in the day, my home turf was not very nice to women found to have the wrong sort of clitoris. Some of the women who managed to not be executed as witches had children and grandchildren - one of whom grew up to be Scotland’s Bard.

Robert Burns was loved by high society for his political, romantic and bawdy poetry. His VERY rude poem, “Nae Hair On’t,” laments a new wife without pubic hair as being tragically out of fashion. Perhaps she needed a merkin.

Merkins - pubic wigs - date back to when Botticcelli and Mechain were working. We don’t know much about what they were made of or who used them, but the convention is they were used to hide syphilis-related hair loss and pubic lice. Prostituted women used them and wealthy women adopted them. What we do know is the glue mattered - John Wilmot, Earl of Rochester, complained that “merkins rub off and spoil the sport.” Please don’t put gorilla glue on your genitals, though.

Victorian Prudery and Razor Capitalism

Victorian women experimented with waxing-like methods using galbanum and pitch plaster. Early pornographic photographs certainly showed that body hair removal was not mandatory.

That changed in 1915 when Gillette introduced the Milady Décolleté razor and told us that female body hair is unfeminine at the same time as fashions changed and sleeves and hems rose. Razor sales soared. A problem was invented, a solution was sold and healthcare started routinely shaving labouring women’s genitals.

Bikini, Bush and Brazilian

1946, just in time to cheer up war weary men, the bikini was unveiled in Paris. It was named after Bikini Atoll - a nuclear test site - and left little room for strays.

Micheline Bernardini modelling Louis Réard’s new swimwear

The contraceptive pill arrived in the 1960s and by the 70s the full bush was a symbol of sexual liberation. In 1972 The Joy of Sex was full of drawings of women with unshaven vulvas and the pornographic magazine, Penthouse printed visible pubic hair.

Then the J sisters changed the pubescape and hairlessness spread beyond Manhattan’s and the 80’s margins.

Today, over 80% of women in the UK, USA and Australia remove some or all pubic hair, and around half of them report cuts, burns, rashes or infections from doing so. About 3% of genital injuries presenting to A&E are related to pubic hair grooming, the summarised advice is “don’t put sharp things near your bits when you are drunk or high - and, please, for the love of the holey, get a bath mat”.

All in all, it’s fascinating to me that in an age when our robots wander Mars we have not yet worked hair risk-free hair removal.

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Global Variation

Many look on Western women’s pubic plucking with bafflement. In China, abundant pubic hair has historically been viewed as sensual and passionate. In Japan, absence of pubic hair in women was anxiously linked with infertility. South Korea leads the world in pubic hair transplantation, where follicles are grafted from the scalp onto the mons. It is done to reduce psychological distress originating from bodily dissatisfaction, and it is expensive. It seems every society finds a way to tell women their perfectly normal bodies are wrong.

Where Does Feminism Sit?

At the risk of sounding like I’m on a disappointing podcast - I’m a feminist, but…I don’t give a jot about what women do with their body hair. The one thing that women’s rights activists agree on is that women should have freedom of choice. If you want to pluck yourself like a Christmas turkey then I’ll fight for your right to access aloe vera, sister. If you think a full bush is the feminist’s uniform then I’ll cheer for your bikini line stragglers. Some women remove their pubic hair because they like it, others as part of their faith, some view total hairlessness as distasteful infantilising, and many have absolutely no opinion on their pubic hair whatsoever. These variations are as old as time.

And in case you’re wondering: I have never heard of a man apologising in a health clinic for his pubic hair. That is a cultural asymmetry worth examining.

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If you enjoyed this hairy piece, please like, share or subscribe.

As you know, I’m a women’s pelvic health physiotherapist and becoming increasingly concerned about the unwanted physical effects of gender-related medical interventions.

Pelvic health physiotherapists treat continence problems, pelvic pain, bowel dysfunction, scar restriction and sexual dysfunction. We don’t treat gender dysphoria or provide psychological therapy. But recognising co-morbidities, assessing anatomy and function, and referring appropriately are core competencies for managing complex presentations of any origin. I don’t see that managing issues pertaining to gender is any more challenging than those caused by neurological disease, multiple fractures or frailty.

Physios are regulated by the HCPC, most of us are members of the Chartered Society of Physiotherapy, and many are part of the specialist group, Pelvic, Obstetric and Gynaecological Physiotherapy. At present, to my knowledge, none have provided guidelines for the clinical management of physical consequences of gender-related medical interventions. To be fair, neither have other professional bodies.

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Anecdotally, referrals to pelvic health clinics for females taking testosterone, males following genital surgery or prolonged tucking, people discharged from gender clinics, and individuals who have detransitioned are increasing. We don’t know how many people there are because no systematic data are being collected.

That’s a problem, because this field desperately needs data. Cochrane reviews are recognised as high-quality examinations of current evidence and one was attempted on feminising hormone therapy in males. It found the evidence was too weak to draw any conclusions. Despite decades of gender clinical practice and publications, there is not yet evidence robust enough to generate Cochrane Reviews. What we definitely do know is that low-quality evidence does not equal low clinical importance.

Dr Ruth Parry and I were concerned about this and presented our state-of-the-art review at the CSP conference last November. We included first-person accounts from individuals who had desisted or detransitioned. Our findings were consistent: pelvic floor morbidity appears common in those who medically transition.

Da Silva and colleagues reported pelvic floor dysfunction in 94.1% of females taking testosterone without genital surgery, and that is striking. Fewer than 10% of women aged 20–39 years have a pelvic floor disorder and for women over 80 it’s about 50%. Between 60-80% of elderly, frail women in residential care have urinary incontinence, so this figure of 94% pelvic floor dysfunction is considerably outside expected population norms - that’s a professional way of saying “good grief, what’s going on?”

The Da Silva study reported rates of urinary and bowel leaking, urinary urgency, pelvic pain and sexual dysfunction, including, for females, severe post-orgasm pain lasting for up to three days. We know these symptoms impact on sleep, travel, relationships and ability to exercise, and the people experiencing them have decades of life ahead of them…so why is our guidance mostly focussed on terminology?

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These conditions are bread and butter for pelvic health physios, and yet physiotherapy input is rarely described in gender care pathways. Access to specialist pelvic health services is inconsistent, and for those who de-medicalise, it is often entirely absent. Do we expect these people to manage the predictable and difficult consequences of gender interventions alone?

In the absence of specific guidance, physiotherapists do what we are best at - we listen, examine, establish what is working well and what could be improved (by drawing on established evidence from parallel fields: post-prostatectomy rehabilitation, radiotherapy-related pelvic injury, obstetric anal sphincter injury, menopause-related pelvic floor dysfunction and chronic pelvic pain syndromes), jointly agree a plan that is worth a shot, see what happens, review and progress accordingly.

Management of females might include pelvic floor relaxation or strengthening, pain management, bladder and bowel retraining, and signposting for vaginal oestrogen.

Males who have used high doses of oestrogen, prolonged tucking or had genital surgery present with chronic pelvic or perineal pain, difficulty peeing, incontinence, scar restriction and sexual dysfunction. Physio focuses on reducing muscle spasm, scar management, restoring movement and retraining bladder and bowel patterns.

Tucking is an under-studied and under-considered cause of pelvic pain. It is the practice of prolonged compression of the male genitalia to reduce bulk under clothing and linked with skin breakdown, urinary tract infection and difficulty peeing. The most effective way to reduce tucking-related problems is to reduce, or stop, tucking.

Detransitioners, or, as some prefer to be referred to, de-medicalisers, are a group about whom we know very little. This is a person who has undergone medical or surgical gender-related interventions and later seeks to mitigate or reverse them. Low detransition rates are frequently, and loudly, cited, but robust longitudinal follow-up data are lacking. As the Cass Review highlighted, adult gender services do not systematically follow up individuals who fail to attend. People who self-medicate or have surgery abroad are, inevitably, missing from the data. The best guesstimate to how many there might be can be found in online peer-support spaces. Reddit is, obviously, not peer reviewed, but it is clear that a growing number of people are gathering in informal online groups to exchange advice and seek support - presumably because their needs are not being met by clinicians.

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Am I an “Openly Gender-Critical Activist”?

This essay is based on a talk I recently delivered to healthcare professionals. I received feedback from one person who described me as an “openly gender-critical activist,” and alleged deliberate misgendering, use of pejorative language and a lack of clinical relevance in my talk.

I think this might be because I referred to trans-identified males and trans-identified females, because there is strong evidence that using sex-based language is clearly understood by most people, wheras gender based language is not. Describing documented outcomes is part of the aim of scientific meetings - if critical thinking is perceived as hostile, then I don’t think the problem is the data but, rather, suggests professional scrutiny has been confused with a political agenda. I suppose that’s fair, I do have a political view - which is that people who have gender issues deserve the same level of evidence supporting their care as any other population.

There is some evidence that gender-related distress reduces in some individuals following medical transition. There are also senior voices who argue that affirmation is not a benign intervention for children. Affirmation does not seem to be effective in resolving debilitating pelvic pain, remodelling scar tissue or restoring bladder and bowel symptoms.

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My point, supported by the limited evidence we have to work from, is simple - gender-related medical interventions have common and significant negative consequences and it has to be someone’s job to develop services to manage them.

Nothing should be beyond discussion in healthcare. Difficult conversations need to be had, and criticism, including of me, should be encouraged. I honestly would be relieved to find that I have misunderstood things because if my interpretation of the evidence is correct then healthcare is failing an unknown number of people with predictable complications. Solutions won’t be found by dismissing data, or people, as “gender-critical” but through good, old-fashioned reflective practice and debate.

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Terry Pratchett was a British novelist whose absurd and sharp Discworld series exposes power, reason and foolishness through witches, swamp dragons and a City Watch who are permanently close to collapse but never far from justice.

One of his best characters is The Librarian - originally a man, now an orangutan who says only “ook”. He manages books which can crossbreed, summon demons and twist time. The Librarian preserves knowledge, even if the knowledge is very dangerous. I’ve been thinking about this portrayal of librarianship while real, farcical events at the National Library of Scotland unfold.

An ongoing public scandal erupted under Chief Executive and National Librarian, Amina Shah and the centenary exhibition “Dear Library”. The Women Who Wouldn’t Wheesht is a bestselling anthology of essays about a snapshot of time in Scottish politics, chosen by readers for the exhibition, but then excluded after staff objections

The NLS’s LGBT network decided that displaying a book written by women - including women of colour, lesbians, mothers of women with disabilities, women who have been victims of male violence, and me - presented a “very real risk of harm to staff & visitors”. That’s possibly true, if the book was lobbed at their head by a man - lady arms are usually too feeble to do more than lightly graze a temple.

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The staff, with the support of their trade union, threatened the Chief Librarian that they’d “go public” if they didn’t get their own way…So they got their own way.

I expect Pratchett’s Librarian would have acted rather more decisively. He would have removed anyone frightened of books by the ankle, for their own protection - leaving the Library in peace.

The National Library holds the work of Hitler, de Sade, and Powell but, according to the staff of the National Library - it is my words which are too dangerous to be on a shelf? If a library houses ideas of fascism, sadism and terrorism but cannot tolerate (to use the terminology of the Library Rainbow Warriors) the “lived experience” of a diverse group of women, then it is not a library, it is a museum of permitted thought. “Ook”.

The decision to remove TWWWW from the exhibition triggered so many complaints the library commissioned an independent review of the process. The investigator used expressions like “I entirely reject those views”, his report found that the NLS contravened their own EDI policy and, shockingly, that neither the CEO nor Chair made any attempt to assess the alleged threat to staff.

Amina Shah gave an interview on Front Row where she said:
“That’s right - it was the process - just to clarify, the book was never removed from the display - it was proposed to be included and then wasn’t.”

Chapeau. Ms Shah - book was not removed, just not added - I’m sure it’s not easy to split a hair so finely when armed only with a Radio 4 microphone.

So, the book was put in the exhibition and I can’t tell you the thrill I felt when I saw a book I was in right next to a book by Dr Maya Angelou. Imagine that.

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One of the findings of the report is that staff were to have equality training. There is an unconfirmed account of ‘intellectual freedom’ training being delivered, but we don’t know who by, or whether it was compulsory for the staff who caused all the trouble.

If I was the investigator I’d have encouraged the staff to read the book - I don’t believe any of the NLS staff have actually done so because it’s simply untrue that there is anything harmful or unsafe in its pages…unless you are a First Minister.

What amazes me is that all these staff members still have a job! The staff and their trade union explicitly threatened to cause reputational damage to their employer. In which way was their behaviour NOT gross misconduct?

What’s even more remarkable is that the narrow-minded bullies are having another go! An open letter, signed by 110 arts gatekeepers (and, amusingly - oxymoronically - 13 anonymous signatories) published on Bluesky, says that staff at the library were having an “awful time” - presumably being made to abide by rules and the law constitutes an “awful time”?

Curiously, this Band of Siblings referred to TWWWW as “that book”, avoiding naming it just as carefully as most little wizards avoid naming Voldemort

The latest letter says:

“We stand in solidarity with queer and trans staff at the National Library of Scotland, who in recent months have been subject to harassment and bigotry in their workplace.”

I’m concerned about this - is it a reference to our The Articles Book Group?

Could staff feel harassed by a bunch of mostly middle-aged women meeting in the library to discuss books whilst knowing that sex is real? I hope not - I’d say we turn up, buy the lovely things in the café, tidy up our crockery and chairs, some visit the exhibition, and everyone thanks the staff as they leave - surely that falls somewhat short of “harassment and bigotry in their workplace”?

The editors responded with:

“Freedom of speech is the single most essential condition for a vibrant culture. Stifle the voices of people whose views you disagree with, or disapprove of, and you are left with a society where only a tiny, well-connected elite thrive.
The signatories of this letter, who claim to be drawn from the ‘academic, heritage, arts, literary and cultural sectors’, should be the very people arguing against censorship. Instead, they try to justify it by claiming “inclusivity” for themselves. This is no way for Scotland’s cultural life to be conducted.
We hope the Board and senior managers of the National Library of Scotland will see this for what it is, a form of McCarthyism which should not be indulged further, and has no place in contemporary Scotland.”

Pratchett’s libraries were connected by a sort of wormhole called L-Space which links all libraries, in any universe and of any time. If a Discworld library behaved as though books are unsafe and readers untrustworthy then you you’d expect something curious might happen on the next page.

In this moment it is difficult not to wish for the appearance of an orangutan, and his brisk and effective disciplinary methods at our National Library. If I hear an “ook”, at The Articles Book Group on Friday, I’ll cackle, if that’s the first step towards becoming a wicked witch, then so be it.

If you fancy coming along to The Articles Book Club, please do. Friday 5th, 2–4pm in the Library at the tables next to the stairs. All welcome - it’s not single-sex - bring any book and tell us about it. Here’s a link to a Mumsnet thread explaining it how it works.

The Culture Committee is looking at this debacle, and the more people complain, the higher the likelihood of Ms Shah being called to give evidence. So, if you have concerns about the governance of the NLS please do write to your MSPs (remember, you have eight of them)

Here are some links to useful resources if you do want to write to them.

Suzanne Moore’s Telegraph article

Euan McColm, Scotsman

Susan Dalgety’s Scotsman article

and archived version

link to Nick Wallis’ tweet

link to article about Amina Shah’s choice of book

It has taken me an absolute age to write up November’s books - I’ll get it finished tomorrow, just in time for our next meeting!

Please do like, comment, share and if you want to read more then subscribe! Thanks for reading.

After presenting our literature review at CSP25, (the Chartered Society of Physiotherapy) Dr Parry and I share a members’ briefing outlining the reputational risks we believe the CSP’s position statement on transphobia poses to the profession.

Purpose:
To examine governance, legal, and clinical risks arising from the CSP’s current Equality, Diversity and Belonging structures and its Position Statement on Transphobia; to outline emerging evidence of pelvic floor complications following gender interventions; and to recommend a single, evidence-led review to restore lawful, professional and accountable governance within the Society.

1. Why this matters

The Chartered Society of Physiotherapy is a professional and charitable body. Its credibility depends on lawful governance, professional neutrality, and evidence-based practice. When these principles erode, members disengage, standards blur, and the profession’s collective voice loses credibility.

The Society’s Equality, Diversity and Belonging (EDB) structures were intended to promote inclusion. In practice, the absence of clear governance has allowed advocacy to drift into ideology. This is most visible in the CSP’s LGBTQIA+ Network and the Position Statement on Transphobia, which contain language and activity that risk breaching the Society’s legal, professional and charitable obligations.

At the same time, increasing numbers of patients are experiencing pelvic floor dysfunction following gender interventions. These complex, sex-based clinical presentations require careful management - there is not yet a CSP workforce plan or policy guidance for this work. There are reports of cardiovascular, bone health, neurological and cancer risks amongst people who take high-dose cross sex hormones. We explore this in our literature review which we presented on Friday 21st November in room 1C at 3.30pm, at CSP 25.

2. Governance and accountability gaps

Lack of transparency:
There are no published membership, criteria for appointment, term limits or reporting lines for CSP networks.

Ideological uniformity:
Public communications show a trans-activist perspective, excluding members who hold lawful gender-critical or evidence-based views.

Reputational exposure:
The CSP LGBTQIA+ Network’s social media comments risk implying institutional endorsement of a contested political position and opposition to the views of members who understand that sex sometimes matters.

No evaluation framework:
If there are measurable links between network activities and the CSP’s strategic objectives it is not clear from the website.

Inconsistent safeguarding:
Reports of “hate” from one group appear to be logged and publicised, but there is no visible, equivalent mechanism for members facing harassment due to their sex or philosophical belief. Nor is there any published evidence that such accusations of “hate” are investigated or followed up in line with HCPC (registering body for all physios, occupational therapists, speech therapists, psychologists, podiatrists and more - it’s a massive organisation) Standards of Conduct, Performance and Ethics (Standards 7 and 9), which require transparent processes for managing concerns and treating all parties fairly.

As a regulator-facing professional body, the CSP must be trusted by all members, not just those aligned with a pro-gender ideology.

3. The Position Statement on transphobia

The CSP’s Position Statement on Transphobia contains the sentence:

“It is wrong not to recognise someone’s chosen gender expression.”

Respect for colleagues and patients is essential. But this phrase is ambiguous and risks being interpreted as a ban on referring to biological sex in research, teaching, or clinical communication.

That interpretation would:

• Exceed statutory duties under the Equality Act 2010, which protects against discrimination but does not compel affirmation of belief;

• Conflict with HCPC Standards, which require accuracy and honesty in professional communication (Standards 6.1, 10.1);

• Suppress legitimate scientific discussion, particularly in pelvic health where sexed anatomy is central to function.

The combination of activist messaging and a vaguely worded policy creates a governance hazard: advocacy is mistaken for policy, and a policy with unclear legal clarity. This is of special importance in light of the removal of members posts on iCSP (CSP’s internal discussion network) if those words were deemed to be in breach of the, somewhat open to interpretation, position statement of transphobia. It might be worth examining this in light of the April judgment from the Supreme Court which clarified that the word “woman” has always meant biological sex.

4. The legal landscape

Recent judgments (see Appendix) have clarified three key points:

• “Gender-critical” belief is protected under the Equality Act 2010.

• Employers and professional bodies must balance self expression and women’s rights to safety, privacy and dignity proportionately.

• In law, “sex” means biological sex.

CSP policies must be reviewed to align with these binding authorities. Continuing to operate under pre-2021 assumptions exposes the Society to legal and reputational risk.

5. Clinical implications

Physiotherapists are already treating patients with pelvic floor dysfunction following hormonal or surgical gender interventions.
Peer-reviewed evidence (e.g. da Silva et al., J Sex Med 2023) identifies common complications including:

• Urinary and faecal incontinence

• Sexual dysfunction

• Pelvic pain

We should treat this novel population as any other - by applying critical thinking and reflective practice to the management of significant unwanted effects.

Yet:

• Undergraduate and postgraduate curricula provide almost no training on these presentations.

• There is no examination of the musculo-skeletal, psychiatric, cardiac, pelvic health or bone health needs of this population by the relevant specialist interest groups.

• There is no CSP workforce strategy to meet this demand.

• Service capacity for existing pelvic-health patients remains limited.

Failure to plan for this need will impact waiting times, equity, and safety across pelvic-health services.

6. What we hope will happen:

6.1 Governance and Policy Alignment Review
Examine the remit, governance, and communications of all EDB networks, starting with the LGBTQIA+ Network.

Ensure alignment with the Equality Act 2010, HCPC standards, charity law, and current case law.
Conduct the review with independent oversight to guarantee objectivity.

6.2 Clarify the scope of the transphobia statement
Insert an explicit note:

“This statement does not restrict evidence-based reference to sex, anatomy or clinical outcomes, nor lawful professional discussion of these matters.”

Clarify that “recognising someone’s chosen gender expression” refers to interpersonal respect, not to compelled speech or the suppression of sex-based terminology.

The CSP should amend the Position Statement on Transphobia to include an explicit clarification of scope.

This should confirm that “recognising someone’s chosen gender expression” refers to interpersonal courtesy in day-to-day professional interactions, not to compelled belief or the restriction of lawful, evidence-based communication. The revised wording should make clear that the statement does not limit physiotherapists’ ability to refer accurately to sex, anatomy, or physiology where relevant to clinical care, education, research, or safeguarding. Nor should it override the duties set out in the HCPC Standards of Conduct, Performance and Ethics (particularly Standards 6 and 7) to communicate honestly and accurately.

Both gender reassignment and philosophical belief are protected characteristics under the Equality Act 2010, and the CSP should ensure its policies reflect that dual protection - upholding respect while safeguarding scientific integrity and lawful professional speech.

6.3 Develop a workforce and education plan
Commission an evidence review of pelvic and musculoskeletal outcomes following gender interventions.
Map service demand and training provision.
Develop CPD materials on postoperative and hormonal complications, trauma-informed rehabilitation, and sexual-function support.

6.4 Transparent governance for all networks
Publish membership and appointment criteria.
Ensure diversity of geography, discipline, and belief.
Establish a single safeguarding framework that records harassment or discrimination consistently across all protected characteristics.

6.5 Oversight and sign-off
Require joint Legal, Professional Practice and EDB sign-off for all future public statements relating to protected characteristics.

7. Outcome sought

To protect the CSP’s credibility as a professional and charitable body by ensuring that all diversity initiatives and policy statements are:

• Evidence-based and legally compliant;

• Professionally neutral and inclusive of lawful belief diversity;

• Transparent, accountable, and aligned with the Society’s constitutional aims.

Members have the right, and the duty, to demand lawful, evidence-based governance.

7a. Core Principles for Sex-Based Rights and Professional Integrity

The issues outlined above are not abstract or administrative. They go to the core of what it means to practise ethically and truthfully as physiotherapists. The following principles summarise the professional and civic values that underpin lawful, evidence-based care and equitable governance.

1. Single-Sex Provision - Women and girls must retain access to female-only spaces such as hospital wards, toilets and changing areas, consistent with Schedule 3 of the Equality Act 2010.

2. Fairness in Sport - Competitive women’s sport must be based on biological sex to preserve fairness, safety, and integrity.

3. Prison and Detention Policy - Female prisoners should not be housed with male offenders. Safeguarding must reflect biological sex.

4. Legal Recognition of Sex - Women constitute a protected class in law because of sex-specific needs and vulnerabilities. Policy should continue to reflect that reality.

5. Accuracy in Language - Professional and medical language should describe reality clearly, avoiding ideological or euphemistic terms that obscure sex-based anatomy and data.

6. Freedom from Harassment - No professional should face harassment, disciplinary action or reputational harm for expressing lawful, evidence-based views on sex and gender.

7. Freedom of Belief and Expression - Open, respectful discussion of contested issues is essential to a pluralistic, democratic profession.

8. Safeguarding of Young People - Distressed or gender-questioning minors, particularly those with trauma or neurodiversity, require comprehensive psychological support before irreversible medical intervention.

9. Respect for Sexual Boundaries - No one should be pressured to alter their sexual boundaries or preferences. Same-sex attraction deserves respect.

10. Integrity in Policy and Advocacy - Policy must be grounded in evidence and law, not ideology or political fashion. Institutions that abandon neutrality erode public trust and professional credibility.

8. Next steps for members

If you share these concerns, you can:

• Write to the CSP seeking clarification on the transphobia statement (see model letter below).

• Support a member-led group calling for transparent governance and evidence-based policy. If you’d like to do that please email venusenvyxx@gmail.com with the subject line “CSP”. If you do that we will assume consent for contact. We have experience in building groups which can protect anonymity and take GDPR seriously.

• If you prefer to be anonymous then please join us on this Mumsnet thread.

• Engage colleagues - show them this substack; show them our leaflet (attached below, I’m sorry it’s so massive, I haven’t found how to shrink images yet!); check whether your facilities which say they are single sex are actually single sex; have a look at the online resources listed below; email to the CSP and let them know your thoughts (draft email below).

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Draft Letter to the CSP

Subject: Clarification on CSP Position Statement on Transphobia

Dear Mr Cowman,

I am writing to seek clarification on how the CSP’s Position Statement on Transphobia should be interpreted in relation to academic and clinical work that discusses sex-based anatomy, interventions and outcome measurements.

The statement includes the sentence:

“It is wrong not to recognise someone’s chosen gender expression.”

I support the principle of professional respect for all patients and colleagues. However, this wording may be interpreted as prohibiting evidence-based reference to biological sex in research, teaching or clinical documentation.

Given the HCPC’s standards on honesty and accuracy, and recent case law (Forstater v CGD Europe, Miller v College of Policing, and For Women Scotland Ltd v Scottish Ministers [2025] UKSC 16), I ask the CSP to confirm that:

1. This phrase relates to interpersonal dignity, not to the lawful use of sex-specific terminology; and

2. Evidence-based discussion of sex, anatomy and clinical outcomes does not breach CSP policy.

Clarification will help prevent misunderstanding, complaints, or self-censorship among members engaged in legitimate academic and clinical work.

Yours sincerely,
<name>

<professional details>

Key Legal Precedents and Relevance to CSP Governance

Recent UK case law confirms that gender-critical belief is legally protected. These rulings are binding across the UK and directly shape how the CSP must approach governance, communication, and equality policy.

Recent UK case law confirms that gender-critical belief is legally protected, that professional bodies must remain viewpoint-neutral, and that clinical policy must rest on evidence and biological fact. These rulings are binding across the UK and directly shape how the CSP must approach governance, communication, and equality policy.

Bell & Mrs A v Tavistock and Portman NHS Foundation Trust (High Court 2020; Court of Appeal 2021)

The High Court identified major consent and evidence deficiencies in the Tavistock Gender Identity Development Service; the Court of Appeal confirmed that clinicians bear responsibility for ensuring informed consent. The case established the need for robust evidence and safeguarding in paediatric gender medicine—principles applicable to all clinical governance frameworks.

Forstater v CGD Europe (Employment Appeal Tribunal, 2021–2023)

Established that belief in the immutability of biological sex is a protected philosophical belief under section 10 of the Equality Act 2010. Employers and professional bodies must not treat gender-critical belief as discriminatory or inherently offensive. This remains the cornerstone precedent for lawful belief protection in UK workplaces.

Miller v College of Policing (Court of Appeal, 2021)

Recording lawful gender-critical speech as a “non-crime hate incident” was held to be an unlawful interference with Article 10 rights under the European Convention on Human Rights. Public and professional bodies must remain politically neutral and avoid chilling lawful expression.

Bailey v Garden Court Chambers & Stonewall (Employment Tribunal, 2022)

Barrister Allison Bailey succeeded in her discrimination and victimisation claim after being penalised for expressing gender-critical beliefs and criticising Stonewall’s Diversity Champions scheme. The tribunal held that punishing lawful expression of belief breached the Equality Act 2010. The ruling confirms that employers and professional bodies cannot sanction gender-critical speech simply because others find it offensive.

Meade v Westminster City Council & Social Work England (Employment Tribunal, 2023)

A social worker was discriminated against and harassed by both her employer and regulator for expressing gender-critical beliefs. The tribunal held that such treatment was unlawful under the Equality Act 2010. This case provides a direct parallel for professional regulators, confirming that belief neutrality and procedural fairness are required standards.

Pitt v Cambridgeshire County Council (Employment Tribunal, 2024)

A social worker was excluded from an LGBT staff group after raising sex-based safeguarding concerns. The tribunal found direct discrimination on grounds of belief. The ruling demonstrates that Equality Act protections apply equally within internal staff networks and advisory bodies, not just formal employment.

Phoenix v The Open University (Employment Tribunal, 2024)

The Open University was found to have discriminated against an academic for founding a gender-critical research network. The tribunal held that failing to protect staff from harassment for lawful belief amounted to discrimination. The decision underscores institutions’ obligations to safeguard academic freedom and lawful diversity of opinion.

Roz Adams v Edinburgh Rape Crisis Centre (Employment Tribunal Scotland, 2024)

Counsellor Roz Adams was found to have been discriminated against for expressing sex-based safeguarding concerns in a women-only service. The tribunal upheld her gender-critical belief as protected under the Equality Act 2010. The case reinforces lawful expression and safeguarding responsibilities within single-sex services.

Cass Review (Final Report, 2024)

The Independent Review of Gender Identity Services for Children and Young People (Cass Review) found the evidence base for medical transition in minors to be “remarkably weak,” calling for data-driven, holistic, and sex-specific care. Its findings now underpin NHS policy reform and inform professional duty-of-care standards across allied health fields.

R (on the application of LGB Alliance) v Charity Commission (High Court, 2024)

The High Court dismissed a challenge to the registration of the LGB Alliance as a charity, affirming that advocacy based on sexual orientation rather than gender identity is lawful and charitable in purpose. The ruling confirms that gender-critical advocacy sits firmly within the boundaries of legitimate public-interest work, reinforcing belief neutrality in regulatory practice.

For Women Scotland Ltd v Scottish Ministers (Supreme Court, [2025] UKSC 16)

The Supreme Court ruled that, in UK law, “sex” refers to biological sex, not self-identified gender. This judgment is binding across all UK jurisdictions and defines the legal basis for single-sex services, data collection, and equality policy. The ruling requires all professional and public bodies, including the CSP, to align their definitions and safeguarding frameworks with statutory law.

Peggie v NHS Fife (Employment Tribunal Scotland, 2024–2025, pending)

A nurse challenged disciplinary action for objecting to mixed-sex changing facilities. The case highlights ongoing tension between sex-based rights, equality policies, and workplace governance in NHS Scotland. Though pending, it exemplifies the legal risk faced by employers who fail to apply belief neutrality in implementing single-sex provisions.

Kelly v Leonardo Hotels Ltd (Employment Tribunal, 2025, pending)

The tribunal held that dismissing an employee for expressing gender-critical beliefs was unlawful discrimination under the Equality Act 2010. The judgment reaffirmed that holding and expressing the view that sex is immutable is a protected belief and that employers must balance dignity and expression without compelling ideological conformity.

Hutchison & Others v County Durham and Darlington NHS Trust (“Darlington nurses”) (Employment Tribunal, 2025, pending)

Group of nurses alleging sex- and belief-based discrimination after male staff were allowed to use female changing rooms. The claim reflects growing system-wide confusion within NHS equality policy and underscores the need for clear, lawful guidance on sex-based accommodation and workplace dignity.

Summary:
Across these rulings and reviews, a consistent legal position has emerged:

• Gender-critical belief is a protected philosophical belief under the Equality Act 2010.

• Public and professional bodies must remain viewpoint-neutral and avoid compelled speech or ideological enforcement.

• Policy and clinical guidance must be based on evidence, safeguarding, and biological reality.
  These principles are binding or highly persuasive across the UK and directly shape how the CSP must approach governance, communication, and equality frameworks

Collectively, these authorities create a clear duty for the CSP to review all equality and diversity frameworks, network governance, and public communications to ensure compliance with the Equality Act and current case law. The Society must demonstrate that it protects belief diversity, maintains lawful neutrality on contested issues, and bases all clinical guidance on peer-reviewed evidence and statutory definitions of sex.

My last post was about the court and justice. I described Justice and her blindfold, scales and sword but I didn’t mention that she emerges from Greek myths - or that she is not a single character. The oldest part of her are The Furies, who enforced morality by tormenting the guilty until justice was served. The most interesting thing about her, I think, is not her sex, but that she grew from the civilising of righteous female anger.

The Furies were not monsters or witches (though, the Weird Sisters held a mirror up to Macbeth until he destroyed himself - Shakespeare wrote the Tartan Furies). They appeared when the moral order was broken and restored it by unleashing raw vengeance on those who deserved it.

Dikē appeared later and was a more sophisticated judge. She lived with mortals, observed our dishonesty and corruption and reported those to her father, Zeus, so he could punish the guilty. Dikē was a clype.

The final iteration of Greek justice comes in the form of Athena. The Oresteia tells the tale of a hot mess of a military mission which led to a long war, destroyed a family and led to the development of the courts.

It’s a great story, but, full disclosure, almost all of my Classics Education comes from years of reading Percy Jackson as a bedtime story to one of my kids…Are you sitting comfortably…?

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Agamemnon was obliged to sail to Troy and fetch Helen. Some say she was kidnapped, others that she eloped, but either way, the Spartans wanted her back. However, Agamemnon had really annoyed the goddess, Artemis when he killed her pet stag - so she stopped the wind, preventing the mission from starting, and demanded a sacrifice.

Agamemnon really wants the wind turned back on so he kills his daughter, Iphigenia, on Artemis’ altar, in return she gives the wind a wee boost, and he sails to Troy where fights for a decade. During that time his wife, Clytemnestra, plots revenge for her daughter. Agamemnon comes home and is immediately murdered by his wife - partly for Iphigenia, partly for political power, and partly because she was having a fling with her husband’s cousin who was seeking revenge himself.

Now, Agamemnon’s death created a blood-debt: the Greeks said that the murder of a father must be avenged by the son…so, the couple’s only boy, Orestes kills his mother. Matricide is one of the most infuriating of all the moral outrages, so the Furies set about trying to destroy him.

Athena is watching a young man who is both obedient and guilty being damned for a justifiable crime - and intervenes. She sets up a law court with a jury and replaces the old ways of “endless blood-feud” with evidence and civic judgement. The Furies are, well, not very pleased about this, but Athena appeases them by giving them a new title, “Kindly Ones” and a new role as guardians of justice and the foundations of the court system.

The Furies’ got nice new name badges, plenty of important paperwork and learned to wait their turn - and Western law was established. However, the Furies only behave because justice obeys it’s own rules. If the Polis disrespects justice, the Furies return - so if the courts stop attending to truth, leaders break their oaths or the system looks after itself and not the citizens then the Furies will stop observing Athena’s request to “be kind” and return to the oldest form of justice: vengeance.

It’s a good, if gruesome, story, right?

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The Furies are monstrous but they are not monsters - they are collective conscience which can’t rest when something unforgivable has happened.

So, Justice, in the Greek imagination, grew out of civilised female fury - and that thread can be seen winding through every women’s movement of the last 2000 years.

Consider the Suffragists (NUWSS) who had spent decades petitioning, dealing with procedure, using persuasion and a lot of patience trying to persuade Parliament to give women the vote. They were kindly. The Suffragettes were not - they reacted to the moral injury of the Suffragists being dismissed, patronised and ignored by the polis for forty years. They smashed windows, disrupted meetings, and engaged in civil disobedience. This was Sarah Pederson’s tweet from yesterday:

On Black Friday, 18 November 1910, three hundred suffragettes marched to Westminster to ask for the vote. They were met by ranks of police who beat and sexually assaulted them. This is what happens when authorities mistake women’s patience for obedience. After Black Friday, the state was more aggressive in its treatment of the women, like the Cat and Mouse Act.

Black Friday wasn’t the end of the struggle for the vote - but it was hugely influential. The women knew there would be trouble, that they would be roughed up, and they went anyway. Things were certainly much worse then they expected, but they they persisted. Bravery is not the absence of fear, but doing the thing even if you are scared - usually because the alternative is unthinkable. Seventy-seven years later, Susan Jeffers said “feel the fear and do it anyway.” She wasn’t writing about women’s rights, but it fits what the women did in 1910 and it might be worth considering if you want your rights today.

Speaking of which, I have finished reading Terf Island by Fiona McAnena, about the start of this grassroots movement that I find myself part of. Secret WhatsApp and Facebook groups and secret meetings were how the women organised - Fiona describes the violence women were subjected to - women who want to gather and talk about matters which affect us are still met with harassment and violence. It doesn’t stop us from finding each other.

I think I see a change from the behaviour of the women detailed in Terf Island, in Sarah Pederson’s book, The politicization of Mumsnet and The Women Who Wouldn’t Wheesht. Those women methodically scrutinised legislation; produced briefings; attended committee sessions; submitted consultation responses; and did the forensic labour that the Scottish Government should have done itself when it produced the appalling GRR Bill. They were patient, procedural, scrupulously factual and played an important role in modern civic life - for years. It seems to me that we watched them being dismissed, patronised and ignored for years…

There is a growing wench resistance, but it is truly grassroots, so the institutions haven’t quite worked out how to measure or manage us yet. We can’t be polled and there’s no membership, but we are everywhere - women who want their rights to privacy, safety and dignity are in every political party, at every school gate, and in every institution. There are helpful and smart people talking about sex and gender in workplaces. We have gained skills, and we might feel the fear, but we are doing it anyway. There is no alternative: women’s rights are not an optional extra.

What we are seeing is the casual disregard for the foundations of civic life. When the police and justice allow themselves to be used as a tool of abuse, trade unions dismiss women’s issues, academia dissuades debate, and governments ignore the law, then the Greek myths suggest that is when the Furies will rise.

So, if you have contributed to the damage of the social contract then the Percy Jackson series about the Greek Myths has some advice:

“Brace Yourself”
Rick Riordan, The Sea of Monsters

Can I suggest you stop ignoring the nice ladies? Patience is finite.

And if you are a woman who wants the words you need to describe the issues which affect you - consider speaking up. I’ll do a post with links to where to find people and organisations - you’re not alone, it just looks that way.

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If you found this useful, subscribe and share. That’s how we find each other, right?

Lady Justice with her blindfold, scales and sword represents a core legal value. Her blindfold symbolises that justice is not swayed by status, personal prejudice or a person’s wealth - Lady Justice does not look at litigants, she is not kind, she is only ever just.

She uses her scales to weigh claims, counterclaims and evidence. Look at them, her scales are really small, she has no space to balance emotion on there - only evidence and law.

Her massive sword is her power. The law is authority, and she is quick to use her sword to cut through confusion or obfuscation. Lady Justice isn’t “courageous” - she doesn’t “stand with” anyone, she doesn’t “speak her truth”, she is disciplined and measured, it’s not for her to take risks. We’re told that courage calls, and sometimes, nowadays, it does that literally when your mobile rings and Maya Forstater cheerfully asks you to draft a High Court submission about toilets for a high profile, High Court case.

I had covid - so I wondered if I might be having a fever dream - but “aye, ok, I can give that a go” came out of my mouth.

I know nothing about the law, I mean, I’ve heard of the High Court but I couldn’t tell you if there’s a Low Court (and I’d like to know if there’s an Underneath Court) but, I channelled my inner middle-ability, middle-aged, middle-class, middle-manager man and scribbled down what I have learned from the women I have worked and campaigned with.

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The case: a legal cake problem

The Good Law Project brought a judicial review to challenge the EHRC’s interim guidance on single-sex services. Their position requires the court to accept, simultaneously, that:

1. single-sex toilets must remain single-sex,

2. but must also include males who identify as women,

3. but should still be called single-sex even when men are included,

4. and it is discriminatory to keep women’s toilets for women.

“Soggy Bottom” is something I understand - it seemed to me that this legal layer cake has so many incompatible layers it was an unstable mess that would collapse into political slop the moment Mr Justice Swift so much as glanced at it.

His job was simple: interpret the Equality Act as Parliament wrote it. He dons the blindfold so he can focus on the law, flicks the feelings off the scales and cuts through purposeful obfuscation with his great big sword. Which is why, at a key moment, he said to GLP’s counsel, Mr Daniel Stilitz KC

“This is not the court of social justice.”

Women across the UK hope for t-shirts with that quote on it.

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What an intervention is (and why it mattered)

Sex Matters intervened in the case. An intervention is a formal mechanism that allows a third party to submit:

• evidence the judge would not otherwise see

• arguments the parties may not raise

• context that prevents the court from drifting into unreality

Interventions can influence legal outcomes - the “lesbian intervention” in the For Women Scotland Supreme Court case shaped the Supreme Court’s reasoning.

So, I was deeply flattered to be asked to contribute to this important case, but, aware of the stakes. Get it right and women’s bodily reality would be entered into the public record - get it wrong and I’d undermine the case and gift GLP policies which write women’s rights to safety, privacy and dignity out of the lavvy.

I slugged paracetamol and wrote my evidence.

The three Sex Matters submissions

Maya Forstater: clarity about the law

Maya’s evidence explains why this case exists: institutions have been misled into believing sex doesn’t matter, when all the statute says is it does.

She set out:

• the Equality Act protects sex

• replacing sex with identity confuses everyone

• service providers misapply the law because the guidance is misleading

• this has consequences for toilets, changing rooms, hospital wards, prisons and sport

• clarity is the foundation of safeguarding

Her submission provided a legal map for the issues Michelle and I described.

Michelle Shipworth: male violence in a women’s toilet

Michelle’s submission is a hard read. Her account of her vicious assault is shocking and her evidence forces the court to confront the truth: women are at risk from men in enclosed spaces.

Toilets are where women are physically exposed and more vulnerable than in almost any other public setting. Michelle’s submission supports the voices of women who want single-sex spaces.

My evidence: how women actually use toilets

I explained the physiology, psychology and practicalities of women’s toilet use: women manage blood, breastmilk, urine, bowel function, hormones, cramps, stitches, pads, pessaries, tampons, catheters, miscarriage and pelvic pain in there in ways that men do not have to consider and will never be able to understand.

People of both sexes responded on twitter saying “I never knew that”. Well, if women don’t know their own bodies, how on earth can policymakers, legislators or Mr Justice Swift?

And what about the men who believe they want to be women? Do they have the faintest understanding of that which they seek to emulate? I’m not convinced that they do.

TribunalTweets were refused permission to live-tweet because of anonymity issues raised by GLP. They posted running summaries after each session which meant anyone not in the court room followed the case with fragments on satellite delay.

The judge repeatedly pressed GLP to avoid emotional claims and stick to statute. I was sent messages like:

• “Your submission blew ‘I just want to pee’ out of the water.”

• “This should be required reading for men.”

• “Every employer, schoolteacher, NHS manager and prison governor needs to read this.”

It was humbling, but I was glad that my words might lead to deeds.

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What is happening now?

The hearing is complete and Judgment is reserved, expected within weeks. The outcome will affect every institution that provides toilets, changing rooms, showers, hospital wards, or any service where women’s bodily privacy matters.

The sticky political mess oozing out the bottom layer

There’s an unpleasant after-taste to this case which requires attention: being pro-women’s privacy, safety and dignity is “anti-trans” which I see as a cultural contortion. Safeguarding is not bigotry - but defending women’s boundaries has led to me being accused of “hatred”, saying that women deserve privacy has cast me as an extremist and asserting that sex matters got me described as “dangerous” by my professional peers. Hilarious. 5 stars.

This case (and almost all of the other recent ones) is not about “trans people” as a class - it is about women and the needs of our female sexed bodies.

Women should not need to organise our lives, spaces and safety around the feelings of men, particularly those who demand to intrude in our spaces. Women’s boundaries are not hateful and cases like GLP v EHRC expose that.

Without Sex Matters’ intervention the court might have heard “be kind” and “we just want to pee” - but nothing of the reality of women’s bodies or the impact of men in our intimate spaces.

The EHRC issued its post-hearing statement noting that the material GLP challenged was non-statutory advice, not formal guidance, and that it does not represent binding policy.

The arguments have been made and the matter now rests with the judge. I hope he has plenty of good cake to sustain him.

If you want to read the next inevitable round of “problematic women” here, then please subscribe. It tells the algorithm that women’s rights matter.

This is the image my governing body and trade union, the Chartered Society of Physiotherapy (CSP) used for their April response to the Supreme Court ruling on the legal meaning of sex where they “expressed solidarity with its trans members following a high-profile Supreme Court ruling”. Six months on - is it time the Society showed equal solidarity with its mostly female membership?

In the Good Old Days, which were before 2010 - equality was the watchword of UK public service reform. The goal was to provide everyone with the same opportunities and resources. However, in time it was recognised that people might need different support to reach equal outcomes and equity appeared as a concept in policy frameworks. By 2020, most organisations had embedded equity and roundly congratulated themselves on their moral progress.

Then inclusion was identified as in need of a glow-up. Inclusion meant removing barriers to involvement, but around 2020 most UK universities, NHS trusts and professional bodies had added “belonging” to training modules. It became compulsory on LinkedIn to be seen to promote the concept of a psychological and cultural sense of feeling accepted in the workplace.

I loathe “belonging” as a concept in the workplace. I might hope for a sense of belonging from a football club or book group but professional affiliations should be built on standards, competence and purpose, not the emotional validation of individuals. It was your mother’s job to ensure you felt secure, and how well she managed that is none of your professional body’s business. Using belonging as a metric of success in the workplace means that disagreement has been recast as harm. HR had to navigate how to provide “safe spaces” - and that seems to have resulted in the removal of any intellectual challenge from the workplace. Hashtag-no-debate damages excellence and has no place in healthcare.

The last five years has heralded in bringing your whole self to work - but this carries a subtext of exclusion. For instance, my view that “sometimes sex really, really matters” is not seen as progressive - and it’s clear such views are not welcome on our in-house messaging board, iCSP. Posts by members who correctly sex people or who criticise gender as a concept are removed without a right of reply. A trade union deleting the words of its paying members - it’s quite something, isn’t it? I wonder whether we ever hear from members who are conservative, Brexiteers, Jewish, from a working-class background, or any other group whose views might add actual diversity but are not en vogue?

And why, oh, why, oh WHY, do I need to hear about the sex lives of my professional peers? Prior to 2020 sharing intimate details about yourself in the workplace would raise safeguarding issues, a wee chat with HR and probably a fitness to practice complaint - I do not need to know about my member’s member in order to do my job, not even on International Day of Oversharing. Interestingly, the few comments made on the videos posted on Bi Visibility Day required the following response from the Chartered Society of Physiotherapy:

We sometimes get comments like this when we post about these topics. For the CSP, recognising Bi Visibility Day isn’t about saying someone’s sexuality is more important than their work, it’s about making sure everyone feels safe, respected and able to be themselves at work. That’s a key part of building a stronger, more inclusive profession. If you’re curious, you can read more about our approach here: https://www.csp.org.uk/.../equity-diversity.../strategy

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Bureaucracy over membership

The Chartered Society of Physiotherapy has around 60,000 members. In return for about £40 a month, members receive professional, legal, educational and insurance benefits. For many, the £10 million indemnity cover is the only reason they cough up their cash, and so they are not actually very sure what the CSP actually does.

The CSP is aware that member engagement is low, only about ten percent of members respond to surveys or vote on council matters. They know that if 90% of members are only there for the insurance, they’re not leading a profession but managing a subscription. I’m pleased the CSP is trying to improve this - they have bought in the TUC’s Digital Lab’s “engagement ladder” which is designed to encourage awareness, a “sense of belonging” <eyeroll>, participation and leadership, though I suspect the challenge is how to get the unheard to actually open the engagement ladder emails.

Advocacy replacing governance

In recent years, professional bodies have seen their role as not just representing members but to also comment on political or world events - which puzzles me as very few professional bodies have a foreign office. A professional body can and should speak up when its members are affected by eg war, crime, or discrimination. However, every statement by a governing body should surely answer “yes” to this question:

Is this issue directly related to our members’ professional safety, standards, or scope of practice?

If the answer is no, then the statement belongs in a personal blog.

When a union issues pronouncements on riots before police reports are filed, it has stopped representing members and started narrating events. That’s journalism, and not good journalism, it’s certainly not good governance. These statements are empty gestures and risk annoying members because it shows the waste of CSP staff time which we might think is better spent on the, doubtless dopamine deficient but vital, business of pay, staffing, education and standards. Staff time is paid by membership fees, after all.

Interestingly, the CSP’s statement titled “CSP condemns Islamophobic arson attack”, published on 6 October 2025 (which prompted my comments above) has been removed - the link returns a 404 error. My understanding is that means the page hasn’t been archived or redirected, it has been deleted. For a professional body that still hosts older statements condemning racism, sexism and other forms of prejudice, selective removal raises legitimate questions about governance. Who decides which political or social issues merit official comment, and which do not? If statements of solidarity appear and disappear according to shifting internal politics rather than transparent criteria, do members need to start archiving every communication we see from our professional body?

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The sex and gender drift

Like many health organisations, the CSP’s own safeguarding guidance requires sex-based awareness - yet some of its public statements deny the relevance of sex altogether.

That contradiction runs the risk of undermining members’ confidence in the organisation’s evidence literacy and legal competence. It is time for a full, evidence-based review of every CSP policy, statement and guidance document on sex and gender - to ensure they align with biological fact, best available evidence and UK law.

Female patients have sex-based care needs - for instance; single sex spaces, chaperones, and safeguarding. Providing these services requires defining what a woman is, which is, apparently, somewhat tricky and ill mannered. I’ve never understood why, after all, a baby can identify sex so why on earth does the Scottish Government find it so challenging that For Women Scotland had to help them out by taking them to the Supreme Court who explained it all very clearly?

As I mentioned, on 17th April 2025, in response to For Women Scotland Ltd v Scottish Ministers [2025] UKSC 16, the CSP issued a statement headed:
“The CSP has expressed solidarity with its trans members following a high-profile Supreme Court ruling.”

This framing focuses on identity and sentiment rather than statutory compliance. The ruling clarified that, in law, “sex” means biological sex - a finding with direct implications for clinical language, safeguarding, and equality policy.

It is a professional body’s duty to uphold lawful governance and evidence-based standards; expressions of solidarity are not a substitute for competence. Policy that confuses sex and gender confuses everything from data collection to safeguarding. Patients should expect that their care is grounded in anatomy and law, not ideology, and members should expect that guidance, policy and position statements do too.

According to World Physiotherapy, in 2024, 71% of the CSP’s membership are female. The Supreme Court judgment clarified that the law has always provided single sex spaces for women in places or situations where we are vulnerable, which will matter a great deal to many members of the CSP and much more to the women we work with. Six months on, there has been no further comment from the CSP about our changing rooms, toilets, patient’s right to request same sex care, never mind an expression of solidarity with its female members.

Further to that, there is no specification of whether this figure of 71% is sex-disaggregated or includes members who are trans identified males to record themselves as female. The CSP should clarify its definitions of ‘male’, ‘female’, and ‘woman’ in membership records and whether gender identity is captured separately - and what they plan to do about ensuring their policies and position statements align with the law.

The illusion of representation

When fewer than ten percent of members vote, it is inevitable that a small, highly connected, minority are the ones motivated to stand for election to council and engage in consultations. And so, sometimes a small group, single figure small, sets policy and tone for the entire membership. If everyone on a diversity committee is of similar age, from similar geographical areas, of similar political leanings and has similar ideological thinking then can it be described as diverse and can it produce anything other than groupthink?

Acknowledging biological sex isn’t bigotry, it’s a requirement of good clinical practice. People with gender issues deserve excellence in care in exactly the same way as any other population.

A profession of grown-ups

If you have a resident teenager you will likely already have all your moral instruction, motivational slogans and social-media posturing needs covered in your household. What most members want from their professional bodies is not moral or social justice guidance but transparent governance, a functioning complaints process, excellent negotiation skills, and clear, reliable guidance.

Belonging isn’t created by paying a membership fee and it certainly doesn’t come from alienating values statements. If professional bodies tried some active listening, the sort of skills used by clinicians daily, then they might find their members feel like they belong more and then engage more.

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Call to action

Members who want the CSP to return to evidence, standards and service can request for a member-led review of all CSP statements and policies on sex and gender.
Let’s examine what the law says about sex, what the evidence is for gender interventions (see Cass Review, 2024) and what this novel population’s clinical needs actually are, debate those findings, establish excellence and organise for that to be delivered to the people we seek to serve as physiotherapists. Let’s start with:

• Auditing policies and statements for legal compliance (Equality Act 2010; For Women Scotland [2025] UKSC 16).

• Clarifying language which refers to biological sex and gender identity.

• Publish how sex and gender identity are recorded in membership data.

• Reform governance so member networks are transparent, and accountable.

If you’d like to help make that happen, or if you disagree it is needed, then get in touch - let’s have an open conversation about excellence, professionalism, ideology and integrity. I think there are about a dozen genderists in positions of power and influence at the CSP - if we can get twelve sex realist members to speak up then maybe we can get a constructive discussion so that our profession restores it’s legally literate and reliable reputation.

There are many options - we could form a steering group, draft a member motion, develop a SEEN for physiotherapy, or maybe you have a better idea?
Email: Elaine Miller, gussetgrippers@gmail.com

Links and, should you agree with this, a draft email you could send to our CEO, Mr Cowman, are below.

As I said at the start of this essay, it has been six months since the CSP “stood in solidarity” with trans members because the Supreme Court clarified that when the law refers to “woman” it means “female”. If an organisation issues statements of allyship, it can also issue a statement of fact recognising that biological sex sometimes matters in law, research, and healthcare. The CSP’s next act of solidarity should perhaps be with itself - ensuring its communications, policies, and training are legally literate, evidence based, safe for members and those we seek to serve.

If you value evidence, open debate, and professional accountability, please subscribe or share this post - and not just with physiotherapists, all healthcare governing bodies have become a little tangled in their approach to sex and so are letting down those members, patients and service users who have a gender issue. The more clinicians who understand how policy intersects with law and ethics, the better our professions will be able to provide excellence in care.

Sleeves up, lads, there’s work to be done.

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Links

Mumsnet thread discussing the censorship on iCSP:
https://www.mumsnet.com/talk/doctors_nurses_and_other_hcps_chat_/5048133-physiotherapy-seen?page=13&reply=146844418
CSP statement on Supreme Court ruling (17 Apr 2025):
https://www.csp.org.uk/news/2025-04-17-csp-responds-equality-act-ruling
TUC Digital Lab -CSP “engagement ladder”:
https://digital.tuc.org.uk/measuring-and-analysing-member-engagement-levels-at-the-csp
CSP -Safeguarding and professional duty of care (updated 2023):
https://www.csp.org.uk/professional-clinical/professional-guidance/safeguarding
World Physiotherapy (2024). United Kingdom - Chartered Society of Physiotherapy member organisation profile.
Available at: https://world.physio/membership/united-kingdom

Cass Review:

https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/https://cass.independent-review.uk/home/publications/final-report/

Draft Letter to the CSP

Please adapt this as you see fit.

Subject: Clarification on CSP Position Statement on Transphobia

Dear Mr Cowman,

I am writing to seek clarification on how the CSP’s Position Statement on Transphobia should be interpreted in relation to academic and clinical work that discusses sex-based anatomy, interventions, and outcome measurements.

The statement includes the sentence:

“It is wrong not to recognise someone’s chosen gender expression.”

I support the principle of professional respect for all patients and colleagues. However, this wording may be interpreted as prohibiting evidence-based reference to biological sex in research, teaching, or clinical documentation.

Given the HCPC’s standards on honesty and accuracy, and recent case law (Forstater v CGD Europe, Miller v College of Policing, and For Women Scotland Ltd v Scottish Ministers [2025] UKSC 16), I ask the CSP to confirm that:

1. This phrase relates to interpersonal dignity, not to the lawful use of sex-specific terminology; and

2. Evidence-based discussion of sex, anatomy, and clinical outcomes does not breach CSP policy.

Clarification will help to prevent misunderstanding, complaints, or self-censorship among members engaged in legitimate academic and clinical work.

Yours sincerely,
<Name>
<Professional details>

The Verve - good choons

In the 1970s, our neighbour was diagnosed with “the Big Sea”. I was a child and couldn’t understand why this very exciting news about a yacht was only spoken about when the grown ups thought I was not paying attention, usually in whispers and with head-shakes. Years later I learned our lovely neighbour died without discussing, potentially without even knowing, that she had cancer because her doctor and family had agreed it was better that she was not told.

Perhaps that was for the best, palliative care was in its infancy and end-stage cancer could be a bleak business. Dame Cicely Saunders had only just introduced the then-radical idea that medicine should relieve psychological, social and spiritual pain as well as physical. She saw that good care requires honesty and the hospice movement she founded grew from both compassion and truth.

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Four decades on, it is accepted that we no longer either lie by omission or directly to patients. Truth is the foundation of informed consent. Which is why the language of “inclusive language of gender” troubles me…

For instance, the phrases “transitioning female-to-male” or “male-to-female transgender,” as if sex can be changed. Why? It’s not truthful.

The literature uses eg “male to female” to describe these people, but the accurate and scientific description would be “male to feminised male” or “female to masculinised female”. Saying anything other than that is not accurate.

Dame Cecily’s work showed us that kindness without honesty denies excellence in care. It was not, at the time, possible for my neighbour’s cancer to be cured, and it is not, yet, possible for a human being to change sex.

Gender interventions can use surgery and hormones to reshape or remove healthy organs, redistribute fat, muscle and hair in order to masculinise a female body or feminise a male one - but to date, 100% of gender interventions have failed. Not one single person has changed sex, your sex remains stable regardless of what you do to your body or persuade yourself is true.

Gender clinics should be honest about the limits of their abilities - to describe these interventions as “changing sex” sustains the delusion or distress of some and fuels the erotic euphoria of others. The profession which once hid cancer now hides reality, still describing its paternalism as kindness.

Transgender is not a defined clinical category. It is a self-declared identity, not a measurable condition, and that makes it very hard to talk about scientifically.

When I say “a transgender man,” do you know whether I’m describing a fifty-five-year-old male person, married, with two children, two pension pots and two OnlyFans subscriptions - or a fourteen-year-old female with autism and acute discomfort about her changing body?

“Transgender” does not adequately describe both individuals and that ambiguity creates two problems: an epistemic one - undefined terminology makes clear reasoning impossible - and an ethical one, because professionals who even notice the difference, never mind try to debate it, risk sanction. See the female NHS staff currently in court because they spoke up - Peggie and Darlington - and they only spoke up about their own sex based needs, not those of patients or colleagues.

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In clinical work every referral, assessment, intervention and safeguarding consideration depends on understanding.

Gribble and colleagues have documented how desexed language in research and policy erases the very people health care is meant to serve. Replace women and mothers with bodies with vaginas or pregnant people, and you lose clinical precision. You can’t record obstetric injury, study prolapse, or audit outcomes in maternity care if you can’t even say woman. Harm is done, and the person who is harmed is usually a woman or child.

I am a member of The Chartered Society of Physiotherapy which warns that “misgendering” might “affect a person’s feeling of belonging” and that “Challenging misgendering is an important part of being a trans ally.”

I have never yet managed to make sense of this. You can only “misgender” if you first accept the premise that each person’s gender is self-declared, in which case there’s no standard by which “misgendering” can be measured. There is a circularity:

• If “gender” is subjective, then “misgendering” means “correctly sexing.”

• If “gender” is a synonym for sex, then “misgendering” is impossible, because sex is not mutable.

My patient can insist that her left knee identifies as the injured right one, but I’m not going to apply ice and compression to the non-swollen joint because that would not be excellence in care.

“Desexed language is likely to have an adverse impact on people with low health literacy and language skills, risk alienation, and cause confusion, especially in non-Western countries and cultures.”

Bartick et al, 2025

When the NHS replaced “women” with “people,” they produced the now-notorious line:

“Eight in ten people under forty will get pregnant within a year of trying.”

“Kind” has also been corrupted - it now commonly means submissive, or, at the very least, collaborative with unforgiving gender ideology. Organisational policies became “inclusive” which is now a common euphemism for “mixed sex”, without considering the impact on the women whose needs and rights were subsequently denied. That doesn’t seem very hashtag-be-kind to me. If you are a gynaecologist who thinks vagina is a terfy word, then I wish you the very best of luck explaining to a woman why you recommend a vaginal pessary to support her prolapse.

Somewhere between diversity training and employment tribunal, we stopped speaking precisely and for reasons unclear, professional bodies decided that accuracy is bigotry.

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Clinicians navigate sensitive topics with skill every day. I simply reject the idea that it is somehow more challenging to build a therapeutic relationship with someone who has a gender issue than with someone who has eg faith based requirements which might impact on a care episode. Gender reassignment** is one of nine protected characteristics, none of which are more important than the others, and, anyway, the principles of patient centred care have not changed and apply to everyone. Some people have no protected characteristics, get over it!*

What should professional bodies do to ensure professional integrity in communication? I think there are four main considerations:

1. Confirm that sex is binary and immutable.

2. Protect factual language in research, education and record-keeping.

3. Ensure policy distinguishes belief from evidence.

4. Defend members who use accurate terminology.

I expect my childhood neighbour died knowing that those who loved and cared for her were lying to her, and that pretence of ignorance may well have provided comfort for everyone enduring such a difficult situation.

However, history is clear - the usual outcome of something built on a lie is negative - see Lysenkoism, Jonestown, Enron or any of the many other examples of the endpoint of lies, incompetence or delusions. It is sixty years since Dame Cicely demonstrated that truth, even that which is difficult, is more effective at managing pain than coddling. I don’t suppose she’d see anything good coming from grammar-based professional misconduct.

I am aware that opinions on this vary. If you object to what I am saying then I’d welcome debate:

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If you prefer to complain then my HCPC number is ph47101. If you would like to complain to the CSP then do so here. However, I really think that Bob Hoskins was right - it’s good to talk.

*sort of - some people don’t belong to any group considered disadvantaged under equality law.

** thanks to those who pointed out that I had missed “reassignment” off the description of the protected characteristic. Having a gender identity is not enough, engaging in reassignment is the requirement for the protection. Of course, what exactly that means is yet not tested in law.

Share it, discuss it, argue it. And if you want more heresy, please subscribe!

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There is an old joke that one species has never been hunted for its skin: the pubic hare. And there’s a new joke that the knickers are the brainchild of MerKim.

This week, Kim Kardashian launched her $32 Faux Hair Micro String Thong, and managed to flog all 12 colours and 9 sizes in less than 24 hours.

They look like half a sporran

THIRTY TWO DOLLARS for a pair of thrush-inducing knickers? Can this scrap of nothing even count as a pair? My dentist gave me something more substantial for flossing my teeth.

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THIRTY TWO DOLLARS to, what, double decker? No, of course, this is aimed at fashion aware women with baldy fannies who have invested time and laser in denuding themselves of all genital hair, and who see that next season is not just fuzzy on the horizon.

Why do women remove their pubic hair? Well, usually, because they want to. Women say they prefer the feeling, it feels cleaner, they like the look. I have absolutely no opinion on what women do with their pubic hair, but it bothers enormously me that in clinic women regularly wave disappointedly over their crotch and say “I’m sorry, I didn’t have time…” as if a healthcare appointment requires a wax job. It doesn’t, by the way. Your friendly fanny physio, GP, practice nurse or gynaecologist doesn’t give a hoot whether you have or don’t have pubic hair - we’re honestly only glad that you kept your appointment because, dearie me, how long have you been putting up with those symptoms for?

I’m am a bit miffed that capitalism uses shame to create unrealistic body standards and insecurities in women so they can sell us solutions to entirely made-up issues - like body hair. I mean, look at Sue Jones-Davies in Monty Python’s The Life Of Brian - what’s not aspirational about this woman?

As with anything in or on a human body, pubic hair has a purpose. And, as with most things in or on a human body, we’re not entirely sure what it is.

Our chimpanzee cousins don’t have extra hair around their genitals, so why did humans evolve a thatch down below? The UCL virologist Robin Weiss once speculated that after we began walking upright, we developed a “thick bush of wiry hair” around our genitals to signal sexual maturity, trap scent and waft pheromones - a biological eau-de-shag-me. The glands there release sebum and odour cues that attract mates. Several experiments have shown that women rate men’s unwashed T-shirts as more attractive if their immune systems are compatible. In short: smell matters for attraction, though, perhaps some of us wouldn’t mind a bit of Febreeze on his bathroom carpet (joke, no one would have a bathroom carpet <stern stare>)

Now, modern humans aren’t naked apes. We’ve got the same number of follicles as orangutans, but we produce wisps, not pelts.

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Pubic hair protects delicate skin from friction by wicking moisture and stopping fluids (urine, sweat, vaginal secretions, champagne) from pooling on delicate tissue. It lowers STI risk, though probably because shaving micro-cuts invite infection rather than the hair itself is protective like eyelashes and nostril hair. And, it can make sex feel smoother - hair-on-hair rubbing is less “ouch” than skin-on-skin rubbing.

Spread and the Mound of Venus

Pubic hair grows from the mons pubis - a fat pad over the pubic bone. Fat pads exist to protect sensitive structures. Without one, you’d bruise your bone every time you fell off a bike or spent time with a clumsy but enthusiastic lover.

Hair can go from hip to hip, meander south to your thighs, north to your navel, or be barely there at all. Bum-fluff to Wookiee is all within the range of normal.

Removal: a long-standing fad

A 6,500-year-old obsidian razor was found in Turkey, Ancient Egyptians used copper blades, Roman ladies had slaves called picatrices to singe their pubes into shape. A 1532 beauty manual suggested boiling together arsenic and quicklime and smearing it on your bits until “the skin feels hot - then wash quickly so the flesh doesn’t come off.” This is also the first recorded account of why patch tests matter.

Not much has changed, we still waxing, sugar, and shave pubes into a Bikini (tidy up round the edges), a Hollywood (totally bare) or a Brazilian (bare except for a strip in the middle. If you want this in France you should ask for un billet de métro - ‘cos it looks like the old fashioned, très chic, Paris metro ticket.)

Reclaim the muff

You’re allowed to keep, and enjoy, your pubic hair. Upper-class men once displayed their lovers’ pubes in hatbands, and, if you believe everything recorded in the Beggar’s Benison’s archives, King George IV had a snuff box stuffed with his mistress’s hair - which is in St Andrews University’s collection.

Some women believe removing hair is “hygienic,” but bacteria grows in skin folds, not hair - you don’t think your scalp hair is a biohazard, do you? If you want to keep your pubes then do, decorate it with bows and toss it around like a show pony if it makes you happy.

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If Mother Nature Fails You

If you lack hair and wish you had more then either get yourself a sharpie and colour some in…or, try a merkin, or pubic wig, dates to the 1450s when it is thought that sex workers wore them to disguise hair loss from syphilis; Catherine de Medici later banned her ladies-in-waiting from shaving to prove piety and pox-free status. John Wilmot, the debauched Earl of Rochester, complained that “merkins rub off and spoil the sport.”

It’s not real, but it is a brilliant image

I can testify that a few tacking stitches work a treat at attaching a hastily fashioned merkin to your tights, but, I would suggest taking the time to hem the sodding thing incase yours accidentally lands up making international news and you have to live down the shame of a curling edge…the internet is forever, wondaweb is for long enough. Nowadays, outside of democratic rights to protest, merkins survive mostly in film production. Some actors use merkins as a furry security blanket for intimate scenes, others need a merkin because, like Kate Winslet, they groomed so much coochie-character work is now beyond them.

Time and tresses wait for no ma’am

Just as you get your bikini line in shape, menopause arrives, oestrogen drops, and either the thick jungle deforests or migrates to your knees. By eighty, many women are left with a sort of post-modern Brazilian or her every cloud has a thick silver lining. Either way, all that time and money you spent trying to tame the below-bouffant will become irrelevant.

Cui Bono?

The real question is who benefits? The hair-removal industry will be worth nearly $5 billion by 2027. I’m impressed, it’s the perfect business model: create a customer and you get infinite regrowth. They sell you the razor; and then they sell you the soothing balm for the rash it caused. It’s true what they say, there’s money in muck.

What’s not feminist is judging another woman for her choices. Kim Kardashian and her nylon faux minge is just the latest way for someone to try and profit from the pubic triangle. I’d approve more if she brought out a range of proper kidney warmers instead of the bacteria super-highway that is a g-string.

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We had another lovely book group on 3rd October, with space reserved for us by the National Library of Scotland. I have to say, the staff are friendly and helpful and it is really pleasant to meet in their cafe space.

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We checked on the wellbeing of the The Women Who Wouldn’t Wheesht book in the “Dear Library” exhibition. Happy to report the book was sitting next to Maya Angelou, which took me aback - my own words were there, sitting on the shelf next to Dr Angelou’s? I was force fed Burns at primary school and my paper round included Burns Cottage so it was thrilling when she visited.

I listened to a lovely podcast of Susan Dalgety and Lucy Hunter Blackburn speaking about the book - have a listen to them, and other fabulous women, and even me, on Inciteful Sisters.

Here’s a list of what we read, or listened to, this month. If you want to come along we’ll see you at the National Library at 2pm on 7th November. All welcome, it’s not a single sex space and there are good transport links and the building is accessible (directions).

I’m thinking, do we need to have a Christmas event? Maybe I could run a twitter or youtube live and people who can’t get to the library can join in?

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Our conversation started with the Edinburgh Women’s Fiction Festival attended by a reader - it sounded right up our street. I’ll share their next events.

Here are the books:

The Specimens, Mairi Kidd

(who happens to chair the Women’s Fiction Festival mentioned above, here’s an interview)

A novel about the women in the lives of Burke and Hare - which, if you are aware of Edinburgh history, well, you’ve got to read this, right?

Water, John Boyne

One of four linked novels, this one has a difficult theme, handled with care and the woman who read it says it is clear why this author was nominated for the, stupidly cancelled, Polari Prize.

Hags, Victoria Smith

I’m about the same age as Victoria Smith and enjoyed the book, so it was interesting to hear a woman older than me speak about this book. She did not find that life diminished after her 40s.

The Weaker Vessel - Antonia Fraser

This follows on from women in Roman times last month, and shows women’s issues don’t much change. Apparently, inspiration came from a man sneering “Were there any women in 17th Century England?”.

Where are the Women?, Sara Sheridan

What the world would be like if our streets and libraries were named after women? It’s timeous, as it turns out that Edinburgh, which has more statues to animals with names than women, is about to get a new statue on the High Street to Elise Inglis - who taught us the importance of refusing to go home and sit down.

The Mitford Girls: The Biography of an extraordinary family - Mary S Lovell.

What happens if you let your gaggle of girls run wild in your country estate free of schooling and the male gaze? An extraordinary family, that’s what.

The Better Half: on the genetic superiority of women - Sharon Moalem

The Y chromosome is a broken X chromosome and that’s why women can see more colours, have better immune systems and are more likely to survive as embryos than males.

Hounded: women, harms and the gender wars - Jenny Lindsay

”We all lived it” said the woman who brought this book along - what happened to women who spoke up about gender by a woman who was absolutely hounded for saying reasonable things?

Combatting Cult Mind Control - Steven Hasson

How do you know if you are in a cult? We chatted about the “cult of personality” in feminist groups, and decided we can’t be a cult because of the constant fallings out.

Bonk: the curious coupling of sex and science - Mary Roach

This was my choice. It neatly shows how little we know about the female sexual response. It’s funny and raises important questions like “would you do as the author did and have sex in an MRI scanner for science?”

Best of friends - Kamila Shamsie

Follows unlikely childhood friends from 1980s Karachie to their glamorous adult lives in London.

BBC Radio 4, The Life Scientific with Jim Al Khaleeli - Tim Clutton Brock

Following on from Jane Goodall’s book last month, and just a few days after her death, our listener recommended this interview with a scientist who took his wife and baby to Rum to study deer where he observed the differences in rearing male and female fauns.

Our Listener also recommended Darren Croft’s episode. He was “bright but lazy” at school, eventually diagnosed with dyslexia, became an academic, and

studied the evolutionary advantages of menopause. So, that’s my spirit animal sorted…

The last, but definitely not least, book shared was

Under the Duvet of Darkness - Boiledbeetle, curates posts on Mumsnet during the time the GRR Bill was being debated in Holyrood. Mostly rhyming couplets and sarcasm, there are some very funny reflections. It was pulled together by Boiledbeetle as a fundraiser for For Women Scotland, who spent the money wisely with a job creation scheme for lawyers because our government simply won’t behave.

That’s it. See you next month, Friday 7th November at 2pm in the National Library cafe. Bring a book you have read.

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Video 2 for Get A Grip, in which I wave my wee pelvis model around and tell you about what a pelvic floor is, what it does and why having a good one is smashing. I talk you through how to do a pelvic floor contraction; tips to try if you are not sure you are doing them correctly; ways to remind yourself to do them and what to do if they don’t work.

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Next up is overactive pelvic floors - a non relaxing pelvic floor won’t thank you for pelvic floor exercises; so if doing these hurts or causes pelvic acheing then wait for the next video!

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Get A Grip is my fundraiser to get help managing tech. As you’ll see, this half hour video is too long for social media - my learning curve is steep and I’m grateful for the donations, encouragement and offers of support. I’ll do a post with progress later on in the week.

You can #DoYourPelvicFloorExercises while you watch it and then do that “like, comment, share” thingie if you felt so inclined. xx

shared the story on her twitter here.

Femina Physical Therapy is a physiotherapy clinic in California. It is a long established and respected pelvic health practice marketed squarely at women. The website has lots of helpful information and uses mostly sexed language eg “woman” and “mother”, (there’s a couple of “caregivers” and “vulva owners” in the articles, but let’s stick on today’s topic")

The woman who contacted was seeking support after expecting a female clinician at the practice she chose specifically because the very-pink website signalled “woman” to her. However, into her dimly lit treatment room, walked a masked, trans-identified male pelvic health physiotherapist.

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Think about the steps a woman navigates in order to have a pelvic health appointment:

She has to recognise she has a problem, ignores it at first, tries a few home or over the counter remedies, seeks some advice online, and thinks “I must do something about that” for months or years.

Eventually she might see a GP, look at online reviews or ask friends for recommendations for a private appointment. She finds a clinic, books an appointment, books time off work or arranges childcare and organises her day to accommodate her care.

She works out travel, probably does a couple of chores on the way there, so does some extra hygiene and brings a pair of clean knickers to change into, hoping those are the “right” underwear to be seen in.

She has a think about what she is going to say, how to word the history and speak about her embarrassing symptoms without crying or freezing.

She probably gets there a bit early so there is time for a pee. She feels nervous -talking about your genitals, leaks, or sexual pain is not easy, especially so with someone you have never even met.

In the waiting room she runs her story over in her head: how can she make sure she is taken seriously? She worries that maybe this won’t work, maybe she won’t be fixed.

Then she’s called into a nice treatment room and finds a man willing to examine her vagina.

What would you do?

• Refuse: tell him you expected a woman, demand another physiotherapist.

• Leave: grab your bag, give an explanation, mumble an excuse or say nothing and leg it.

• Grin and bear it: go along with the appointment, because you can’t think straight, and he knows what he’s doing, you’ve waited for ages, you had a male gynaecologist before and this really is sort of the same thing, it doesn’t matter who fixes my fanny as long as it’s fixed, anyway it won’t take long and it’s too late to back out now.

• Overcompensate: enthusiastically answer his questions, let him touch you, make jokes and accommodate anything that makes things easier for him.

Fight, flight, freeze and fawn are common trauma responses. Pelvic health physios should be on the lookout for them, because a woman who defaults to these survival strategies during an appointment is not having her needs met and is not safe.

This particular woman chose flight - she left the appointment and sought support from someone she trusted. Good for her.

I wonder do wonder, though, how many women have been in this situation with this practitioner but were able to advocate for themselves. Many women will swallow down their discomfort and carry on, dissociate during the examination and never go back; or minimise her own feelings and behave in a way that pleases the therapist in order to avoid an escalation of behaviour that she perceives or does not want to be around.

This does harm.

There is no way of building a therapeutic relationship if a patient feels the appointment began with a bait-and-switch. Trauma informed care means ensuring she feels safe - if women lose trust in healthcare they likely withdraw, avoid appointments and their health needs are unaddressed.

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However, women know that speaking up in a situation where gender is a factor means risking being labelled “transphobic”, “difficult” or having treatment withdrawn.

Theresa Steele complained and the hospital cancelled her cancer surgery, Theresa is one of the founders of Caring About Dignity, which campaigns for privacy and dignity in healthcare.

Institutional gas lighting of women is common - Baroness Nicolson raised the case in the House of Lords of a woman who was raped in an NHS hospital ward by a trans-identified male and told by staff that there was no rape as there was “no male” on the ward.

Ayrshire and Arran Health Board’s policy was to remove a woman who objected to having a trans ID male on her ward, and treat her as they would manage someone who was racist.

What should we learn from these cases? If a woman’s right to consent is not absolute and respected in practice then healthcare can become coercive and punishing. The woman who already knows this can endure catastrophic consequences for her health, and the women who know that reacted with gusto to Exulansic’s post. As did the people who think women having rights to bodily autonomy is transphobic, here is a tweet demonstrating both.

Employers’ duty of care

The employee has shut down his social media, I assume he has seen the furore online and I expect some of the commentary has been upsetting. The trans-activists furiously defending him and attacking the women have missed an important point, though…

This “safe zone” rainbow sticker is on the practice website - but for whom is it safe? The physiotherapist must realise by now, if he didn’t at the time, that his patient left because she recognised and rejected his sex. That can be challenging for people who would prefer to be the opposite sex. Which, of course, they can never achieve, but if everyone around you says they see you as you wish to be perceived then it can be confronting when someone refuses to join in.

There will be women who are happy to be seen by a male pelvic health physio, and we’re told this person has a passion for working with those who have gender issues (which is great as that population has disproportionate rates of pelvic floor dysfunction) - but an employer who fails in their duty of care to staff by ensuring patients expecting single sex care are not on the list of a trans-identified man could land up managing an employee’s distress, if not their grievance.

Patients can reject clinicians for any reason whatsoever. About a million years ago I was very loudly rejected with two very loud words from a man in a Glasgow hospital because he did not like my name badge. My maiden name is very Irish Catholic and this gentleman had striking sectarian tattoos proudly showing his depth of feeling about football and religious division - which, in Scotland (for inexplicable reasons) are interwined. That was also measured in real time by the blood pressure machine as he became apoplectic at the prospect of being touched by a Tim.

I didn’t take it personally, it didn’t occur to me to be offended. The man was in a coronary care unit and very unwell, he was having a terrible time and no doubt very scared - which he managed that in the default Scottish way of - looking for a fight. What mattered was calming him down before he could do himself a mischief, so I hurriedly got my most Protestant-looking colleague to see him instead. Patient centred care achieved, problem sorted and peace restored - apart from the agitated beeping of his monitoring machines.

An employee’s potentially hurt feelings are always secondary to patient need. Or, they used to be, before people were told to bring their whole self to work.

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Gender confusion is not new in physiotherapy

About ten years ago, a physio in the USA asked our international gender in pelvic health physio forum for advice - she was seeing a trans-identified male patient who had complications after genital surgery. He asked whether she thought he could ever have sex with a new partner without disclosing his sex and she was not sure how to answer.

The responses practically came waving pom-poms: “You go girl,” “all vulvas are different,” “lube is your friend.”

I was horrified and advised caution - no UK physio in the group should give that advice because sex by deception is a crime. I had heard a trans organisation recommend “disclose before bedroom” - not only because of the legal aspect but because not disclosing potentially puts the trans identified person at risk of assault.

And what do you think happened? I was called names, told I was unsafe to work with trans identified people, reported to an assortment of organisations, and, eventually, booted out of the group without right of reply. I still don’t understand why me wanting trans ID people to not be assaulted or arrested is transphobic, but I’m reliably told it is.

It was my first online pile-on, and, at the time, it felt brutal. It taught me that nobody will try harder to trash your reputation than the person who is most scared that you’ll tell the truth.

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The UK governing body and trade union for physiotherapists is The Chartered Society of Physiotherapy. They have a “Position Statement on Transphobia” which states

“Transphobia: the fear or dislike of someone based on the fact they are transgender, including denying their gender identity or refusing to accept it.”

and that members are “expected to respect the position.”

Some of my professional peers will be of the view that by using sex based language to describe the case in California I am in breach of the position statement. However, I am comfortable with my approach. I have spoken to the woman concerned and she has not mentioned having expectations of her physiotherapist’s sense of self, mental health, hairstyle or preferred pronouns, what she expected was a same sex practitioner - sometimes sex really matters to women.

There is nothing in the above position statement to help members navigate what they should do when a woman’s request for same sex care clashes with the self image of a trans-identified male member of staff.

The statement also says

“However, respecting the human rights of gender non-conforming, transgender, transsexual, genderqueer and non-cis people must go beyond just observing the law as it currently stands.”

“Going beyond the law” is a Stonewall phrase. They entirely misrepresented the law, pretending that the 2010 Equality Act regarded gender identity as a protected characteristic (only sex, sexual orientation and gender reassignment are listed) which was framed as progressive and the right thing to do. Amazingly, not one of the organisations advised by Stonewall considered the impact that “going ahead of the law” would have on women and girls.

For Women Scotland, April 25.

The law in the UK is clear

Thanks to For Women Scotland’s efforts taking the Scottish Government to the Supreme Court in order to clarify the law everyone now knows that women in the UK have always had the right to request female care.

However, what if a male trans-identified doctor considers himself female and says, under oath, that he would treat a woman asking for female only care, as happened in a current tribunal?

When pressed, the doctor shrugged and said that if a patient complained, he’d “find someone else.” Presumably, he thinks women who don’t object because they are unconscious, drugged, in agony, or have a communication barrier are therefore consenting to him treating them?

Michael Foran, a legal scholar explores the Peggie v NHS tribunal on substack at “knowing ius” but I can’t get it to link, so have his Critic article for now, til I fix that.

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Sex and motives matter

Stonewall’s advocacy umbrella shelters transvestite males, many of whom are autogynaephilic - that is, sexually aroused by the idea of themselves as a woman. Paraphilias are known to cluster, many men who find cross dressing erotic also find sexual satisfaction from eg voyeurism, pain or urine - and that puts a big old pachyderm in the corner of the pelvic health treatment room…if you are a predatory paraphilic man (hashtag-not-all-paraphilics) who wants to peep at women, hurt them and get them to share details about their urination then why would you NOT train as a pelvic health physiotherapist?

There is no point in pretending this is not an issue - here is the Women’s Rights Network’s report on the thousands of sexual crimes committed by hospital staff every year. Discussing the depravity of some men does not tar all men with the same brush. Nobody, and certainly not I, is saying that men who embrace their femininity, including those who use hormones or surgery to change their appearance, are therefore risks to women. The problem, which continues to avoid mainstream debate, attempts is - how can we tell which men are able to behave themselves around women, and which cannot?

This is why chaperones exist, to protect professional boundaries and safeguarding. “The good men stay out so the bad men stand out” strongly applies in healthcare - a “good” male practitioner will never put himself where his presence is not wanted or assume silence equals consent, and if he has a kink or two he leaves them at home where they belong and takes his professional self to work.

Fetishises swing

It goes both ways - every now and then a physio forum post reads “had an odd one, man asking for advice” and gives a story of a man describing his pelvic floor problem at length, in detail, on speaker phone to staff at a physio clinic. Her gut said something was off - two or three others respond with “weird, I think the same man called us three times last week” and they collectively realise they have been tricked into being part of some boring man’s callous-handed sexual script.

Professional bodies need to be aware of deviant sexual behaviours and training should help us to spot and manage fetishists, otherwise they fail to protect both patients and staff. (Besides, if I’m going to be part of some tedious man’s fantasy I need to be paid a LOT more than I am currently)

Women routinely feel failed by healthcare

Good institutions, clinics and practitioners already know what to do. They offer chaperones without being asked, treat consent as an ongoing (not a tick box) exercise, and leave their whole self at home so they can provide patient centred care by listening to the women they are paid to help. These measures are cheap or free, and yet sometimes HCPs totally forget that the baseline of good practice is respecting a person’s dignity. What on earth possessed these clinicians to make a tik tok mocking their patients? They were all sacked. Good.

Carol Hanisch popularised the phrase “the personal is political“ in her 1969 essay of the same name. I can’t think how much more personal a woman can get than making herself vulnerable in order to share deeply intimate information with a pelvic health physiotherapist whom she allows to palpate the muscles and organs of her pelvis through her abdomen, vagina or rectum.

The very least we can do for her is, if she asks for one, give her a woman - the old fashioned kind - and that should never have been allowed to become a contentious political issue.

“Would you like to join me at 2pm on Friday 5th September at Scotland’s National Library for my new book group, “The Articles”? The format is a bit different from usual book groups - everyone reads a book they already own, and tells the group about it.

I have a large pile of unread books which I don’t make time to get through, even though I want to. So, the aim of The Articles is to read 10 of your own books in a year. The title and number are a play on words.

If someone uses Scots to call you “an article” it isn’t a compliment - you are being called awkward, outspoken, troublesome - someone who just winnae wheesht.

And, Article 10 of the European Convention on Human Rights says: “Everyone has the right to freedom of expression. This right shall include freedom to hold opinions and to receive and impart information and ideas without interference by public authority.”

This means we have the right to read, to speak and to share ideas - without interference from publicly funded bodies. In some parts of the world, women are banned from reading, writing, or speaking therefor my every unread book by my bed is a symbol of my freedoms.

That’s why The Articles Book Group has no assigned text. Bring any book from your own pile, any subject and any genre. Read from it, tell us about it, recommend it - or don’t - practise your Article 10 rights with others who value them, share ideas and book recommendations.

National Library of Scotland, George IV bridge Edinburgh Friday 5 September, 2- 4pm. All welcome. Look for this “The Articles Book Group” sign and my smiley face. Perhaps after we have read, spoken and shared we can visit their “Dear Library” exhibition… Please share

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My motivation was partly annoyance with the National Library of Scotland who had removed a book nominated for inclusion in their "Dear Library"exhibition because of staff pressure. A book I had been flattered to be invited to contribute to was regarded as beyond the pale by people who had, I assume, never read it.

The Women Who Wouldn't Wheesht is an anthology of essays about the short period of time in Scottish politics during the Gender Recognition Reform (Scotland) Bill, curated by Susan Dalgety and Lucy Hunter Blackburn, published in 2024 and I’m thrilled to have been included in a group of women I find, without exception, hashtag inspirational.

The library asked the public to nominate books which had influenced their lives for the exhibition marking its 100th anniversary. TWWW was nominated but the NLS’s LGBT+staff network thought the book might cause them "severe harm", so our book was removed from the exhibition. Naturally, many people were surprised that a library would censor a book, and I’ll admit to raising an eyebrow because the NLS holds copies of Mein Kampf*, but my essay about not-flashing Parliament was beyond the pale?

Susan and Lucy met with the library and reported it was a “constructive meeting” - and I thought “ha, ha, ha, I bet it was.” I aim to never on the receiving end of those women’s considered, polite and astute assessment of all the ways I had gone badly wrong…

So, on the 5th September fifteen of us met in the (rather nice) cafe of the National Library. Everyone brought a book to share and it was WONDERFUL - though, it did not solve my issue of “too many books to read” because I have added to my “ooooh, that sounds interesting…” list.

The book club isn’t a protest, after all, people meeting in a library to talk about books cannot be described as subversive, can it? The list of books brought is below, it turned out there is a common theme...

One woman even brought The Women Who Wouldn’t Wheesht as her book. Tracy Edwards is a woman who understands the unexpected and unfair impacts of not wheeshing.

It was a lovely couple of hours, there was a lot of laughter, a few tears, a poem, excellent coffee and cake and it was all very uplifting.

One of the suggestions was to make sure that the library has titles written by women about our lives available in audio, digital and printed forms. You can request and suggest books from any library, but if you want to do that in Edinburgh use this link: suggest books for purchase

and this one to reserve:

reserve books from Edinburgh libraries

Some of us visited the exhibition afterwards and enjoyed seeing TWWW in its rightful place:

and messages of both encouragement and annoyance from exhibition visitors:

We are meeting again on Friday 3rd October at 2pm, and I’m delighted to say that the library staff have helpfully reserved us space to the side of the main staircase.

If you are free next Friday and fancy talking about books or having a coffee and cake with us then do come along. Everyone is welcome and you can bring whatever book in any genre and any format that you would like to share.

I’ll bring badges and bookmarks and pop into the exhibition to make sure our book is still in place. The Dear Library exhibition runs until April so it’s worth keeping an eye on it as, perhaps I’m cynical, but, this feels familiar, like the wobbly beginning of another long game…

I’ll list the books we read below. My advice is to pay it absolutely no heed, because you’ll only land up adding to your unread book pile…

*to be fair, you can’t just wander in and pick up writings of totalitarian propaganda off the library’s shelf, if you want to read Mein Kampf you have to request access.

You can explore Edinburgh Libraries collection of LGB-and-quite-a -lot-of-T+ books here.

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The Articles Book Club, September 25

Three Guineas, Virginia Woolf

https://www.goodreads.com/book/show/18854.Three_Guineas

Agnotology, ed by Robert Proctor, Londa Schiebinger

https://www.goodreads.com/book/show/2748888-agnotology?from_search=true&from_srp=true&qid=S7PN8ZK8zM&rank=1

Women’s Rights, Gender Wrongs, the global impact of gender ideaology, ed by Kath Aiken and Sally Wainwright

https://www.goodreads.com/book/show/199340052-women-s-rights-gender-wrongs

Hounded, Jenny Lindsay

https://www.goodreads.com/book/show/213713149-hounded?from_search=true&from_srp=true&qid=v9vdxniria&rank=1

Through a window:My thirty years with the chimpanzees of Gombe, Jane Goodall

https://www.goodreads.com/book/show/135490.Through_a_Window

The End of the World is Flat, Simon Edge

https://www.goodreads.com/book/show/56792257-the-end-of-the-world-is-flat

The Women Who Wouldn’t Wheesht, ed by Susan Dalgety and Lucy Hunter Blackburn

https://www.goodreads.com/en/book/show/209456059-the-women-who-wouldn-t-wheesht

The Industrial Complex, Darren McGarvey

https://www.goodreads.com/book/show/229078772-trauma-industrial-complex

Women and the Piano, Susan Tomes

https://www.goodreads.com/book/show/189206102-women-and-the-piano

Patricia Highsmith - Her Diaries and Notebooks

https://www.goodreads.com/book/show/56769615-patricia-highsmith

In Ethiopia with a mule, Dervla Murphy

https://www.goodreads.com/book/show/1419323.In_Ethiopia_with_a_Mule

Women are blamed for everything, Dr Jessica Taylor

https://www.goodreads.com/en/book/show/53255264-why-women-are-blamed-for-everything

A map of absence, Palestinian writings on the Nakba, ed by Aref Alshaer

https://www.goodreads.com/book/show/38683119-a-map-of-absence

Woman, Natalie Angier

https://www.goodreads.com/book/show/60885.Woman

The many faces of Josephine Baker, Ceravantes

https://www.goodreads.com/book/show/22180974-the-many-faces-of-josephine-baker

A proud taste for scarlet and miniver, E L Konigsburg

https://www.goodreads.com/book/show/73298.A_Proud_Taste_for_Scarlet_and_Miniver

Unfortunately, she was a nymphomaniac, Joan Smith

https://www.goodreads.com/book/show/211051402-unfortunately-she-was-a-nymphomaniac

What is right with feminism, Elaine Storkey

https://www.goodreads.com/book/show/284037

The Handmaid’s Tale, Margaret Atwood

https://www.goodreads.com/book/show/38447.The_Handmaid_s_Tale?ref=nav_sb_ss_1_18

The Diary of a Nobody George Grossmith and Weedon Grossmith

https://www.goodreads.com/book/show/535856.The_Diary_of_a_Nobody

Transsexual apostate, Debbie Hayton

https://www.goodreads.com/book/show/199501640-transsexual-apostate

Orlanda, Jacqueline Harpman

https://www.goodreads.com/book/show/1845361.Orlanda?from_search=true&from_srp=true&qid=juM3urnAIT&rank=1