Cosmetic Surgery and Sex Change in Islamic Laws

The traditional Islamic emphasis on healthy appearance and adornment supports cosmetic surgery, as long as the procedure causes no harm.

Classical sources reveal a number of occasions in which the Prophet performed a sort of organ transplant and repaired a detached limb or a broken nose. Bone and teeth transplants were also common, and the jurists regarded such transplantations as permissible in the Shari‘a. Even the use of parts of animals forbidden for food — like swine bone grafts — were permissible when there was no other alternative. In most of these examples in the early sources, the goal was very clear: the procedure was permissible mainly for corrective purposes. Since the Qur’anic injunction was to preserve one’s person, it also provided the grounds for extrapolating permission and even the obligation to seek a remedy for any injury that led to dysfunctional or deformed organs. Implicit in such rulings was the duty to maintain one’s health and appearance; accordingly, the Prophet emphasized natural instincts to perform cosmetic and hygienic tasks such as the regular cutting of nails, trimming of the beard, and dental care. Dental hygiene assumed great importance in the rules of cleanliness and was emphasized on different occasions by requiring the regular use of a toothbrush at different times in a day and by discouraging the eating of sweets, which the Prophet regarded as harmful to teeth.

This traditional Islamic emphasis on healthy appearance and adornment supports cosmetic surgery, as long as the procedure causes no harm. An additional condition mentioned in some sources suggests that cosmetic surgery should not lead to deception regarding one’s true identity. Hence, while permitting women to get rid of excessive facial hair (ilnimas), the ruling required them to seek their husband’s permission to avoid deception (tadlis). The Hanbali jurists have forbidden women to undergo any cosmetic enhancement (e.g., making one’s eyebrows stand out) that made them resemble a prostitute ( fajira). A more prohibitive case is given in Bukhari’s compilation, in which a woman, having lost her hair during an illness, sought the Prophet’s permission to use false hair. The Prophet denied her the permission, saying that God curses the one who engages in such an act of cosmetic enhancement. In other words, according to a number of traditions in authoritative Sunni sources, corrective cosmetic procedures to enhance one’s beauty are impermissible if they lead to deception about one’s true identity and if they cause corrupt social behavior.

Among reasons cited for the prohibition of enhancement surgery is the presumed inviolability of various parts of the human body. However, the Shafi‘i jurists, on the basis of the principle of necessity (which also permits the consumption of a cadaver under dire conditions), approved of the use of bodily parts to perform such surgical procedures, whether involving skin, bone, or muscle tissue, and whether derived from the body of the patient or a fresh cadaver. In addition, these jurists required that the attending physician should verify, however speculatively, that such a cosmetic surgery would be beneficial.

As seen above, cosmetic surgery to enhance one’s appearance that would also lead to a change of one’s features so that it would change the identifying imprint of an individual is regarded as suspicious in the Shari‘a, and hence illicit. The Qur’anic passage that has been commonly cited as documentation for this ruling is the one in which the rebellious Satan promises God, “I will assuredly . . . lead them (human beings) astray, and fi ll them with fancies . . . and I will command them and they will alter God’s creation.’ (Q. 4:119) The last part of verse (“they will alter God’s creation”) is interpreted to mean that Satan will lead human beings to change their nature and the way they look physically so that they will not be identifiable with their original identity as given at birth. In other words, introducing changes in and tampering with God’s original creation is regarded as satanic.

This brings us to the issues of sex-change surgery. Is it permissible? A real change of sex by means of a surgical procedure is not regarded as objectionable by some jurists. However, there is no exception to the ban on looking at and touching of the private parts by a person who is legally forbidden to do so. The surgery should be done in such a way that it would not lead to this or any other forbidden act. However, other jurists regard any tampering with male and female identity as immoral and an affront to God, the creator, especially when it involves the changing of an organ or destroying one to replace it with another. In addition, these latter jurists rule out any corrective surgery to create male or female reproductive organs for a man or woman who emotionally feels like he/she is existentially a member of the opposite sex.

The jurists who oppose sex-change operations cite the potential harm that such a procedure can cause in mutilating the original organs in order to create the desired sexual identity. Moreover, as these jurists argue, when someone is essentially created as a man or a woman, then a true change of sexuality is impossible and is beyond the reach of scientific technique. The reason is each sex has basic characteristics that are implanted in the womb and that are so essential to one’s being that no earthly power can alter them.

In sum, according to the jurists opposed to sex change, medical intervention through surgery and administration of special medicine which causes man’s facial hair to disappear or woman’s breasts to grow in size, or a vagina to replace male and a penis to replace female reproductive organs, does not actually make a man a woman or vice versa. Anyone who undertakes this unlawful procedure has disobeyed God’s command. Moreover, according to these scholars, as far as the Shari‘a goes, the legal status of this individual remains what it was prior to the sex change. In other words, by mere elimination of some parts of the body the situational aspect of a person’s manhood or womanhood does not change in such a way that one can assert that the legal status should also change. This impossibility of a real change in a person’s sex, according to these scholars, can be construed from some of the verses of the Qur’an. Thus, for instance, God says: “He creates what he will; he gives to whom he will females, and he gives to whom he will males or he couples them, both males and females; and he makes whom he will barren” (Q. 42:49–50).

The selection taken from “Islamic biomedical ethics” by Abdulaziz Sachedina.