Gender Incongruence as a Condition Relating to Sexual Health: The Mental Health ‘Problem’ and ‘Proper’ Medical Treatment

In the 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) there has been a significant change in the placement of gender identity conditions. Gender incongruence will now be reclassified within the chapter ‘Conditions Relating to Sexual Health’. In this paper we suggest that there are a number of potential ethical and clinical problems with this. One problem is that sexual health conditions are often assumed to have psychofunctional aetiology, so the rejected psychiatric classification may reemerge regardless of reclassification. The second problem is that reclassifying gender incongruence as a condition relating to sexual health could lead to a misguided understanding of gender identity as an issue that is necessarily or inherently related to one’s sexuality and subsequently to an imprudent focus on genital incongruence.. We suggest that understanding gender incongruence as something relating to one’s sexuality and thus becoming ultimately integral to a person’s sexual health may shape the perception of what is proper medical treatment. To explain how this may happen we, in part, consider the case of intersex conditions and specifically so-called ‘genital-normalising’ surgery. We do not want to compare intersex with gender variance, yet we argue that there is a lesson to be learnt from the way clinical nomenclature may shape the understanding of human diversity and health and disease, and therefore influence the provision of medical care, specifically genital surgery. Using the case of intersex conditions or variations of sex characteristics, pathologised as Disorders of Sex Development, we can further argue that focusing on medical anatomical or functional sexual health prognosis fails to consider gender identity in its entirety. We therefore suggest an alternative chapter entiled ‘Conditions Relating to Sex and Gender Identity’.