The Vatican has issued a strong warning against “gender theory” and said that any gender-affirming surgery risks threatening “the unique dignity” of a person, in a new document signed off and approved by Pope Francis.

Titled “Dignitas Inifinita” (Infinite Dignity) the declaration focuses on what it describes as a range of threats to human dignity, including poverty, the death penalty, war, assisted dying, abortion, sexual abuse and the abuse of women.

The text, published by the Vatican doctrine office on Monday, states that attempts to obscure “the sexual difference between man and woman” should be rejected. “It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception,” it adds.

The document is largely a re-stating of Catholic teaching on these topics but does not seek to isolate one issue – such as abortion – but says it emphasizes the equal dignity of all people, regardless of their circumstances. On abortion, it strongly reiterates what the pontiff has said in the past, that the “defense of unborn life is closely linked to the defense of each and every other human right.”

The document also addresses surrogacy, which it says “violates” both the dignity of the child and the woman, who “becomes a mere means subservient to the arbitrary gain or desire of others.” Pope Francis has recently called for the practice of surrogacy to be banned.

The pope has spoken out strongly against gender ideology in the past, describing it as “ugly” for erasing what he says are distinctions between men and women. The latest Vatican document quotes Francis by describing it as a form of “ideological colonization.”

It states that gender theory “intends to deny the greatest possible difference that exists between living beings: sexual difference” which it says is “the most beautiful and most powerful of them.” Gender-affirming surgery, it adds, is to be avoided because “the body serves as the living context in which the interiority of the soul unfolds and manifests itself” but the document says medical intervention is permitted for those with “genital abnormalities.”

While Francis has been critical of gender theory, he also provided pastoral support for transgender Catholics. The pontiff has met a group of transgender Catholics from Torvaianica, south of Rome, meeting them regularly, inviting them to a lunch in the Vatican along with 1,200 marginalized and homeless people and giving them front-row seats at one of this audiences.

The Vatican’s doctrine office – now led by a close ally of Francis, Argentinian Cardinal Victor Manuel Fernández – has also recently allowed for transgender people to act as godparents at baptisms and witnesses to marriages, a change to a ruling in 2015 when the Vatican said transgender people could not act as godparents.

Not all Catholics have agreed with the Vatican criticisms of gender theory. One Catholic LGBTQ+ group described a 2019 document from the Vatican’s education office on gender identity as a “harmful tool” while a deacon (a member of the clergy who can be married), the father of a transgender daughter, expressed his concern.

The latest Vatican document identifies various “violations” to human dignity, including in the digital world, pointing to the trends where people’s personal lives are laid bare and “combed over” anonymously. “Such tendencies represent a dark side of digital progress,” it adds.

It also cites the death penalty, which Francis has repeatedly condemned, and which it says “violates the inalienable dignity of every person.” The pope has changed Catholic teaching to make the death penalty “inadmissible”  although this has seen him criticized by some conservative Catholics.