The Vatican has published a speech citing a moderated position on gender reassignment surgery, which calls for compassion in exceptional cases of “strong dysphoria”.

The Argentinian prelate, doctrine chief Cardinal Victor Manuel Fernández said: “there are cases outside the norm, such as strong dysphorias that can lead to an unbearable existence or even suicide. These exceptional situations must be evaluated with great care.”

He explained: “We don’t want to be cruel and say that we don’t understand people’s conditioning and the deep suffering that exists in some cases of ‘dysphoria’ that manifests itself even from childhood.”

Last year, Pope Francis signed a document asserting that “sex change intervention” risks undermining a person’s “unique dignity”.

“It follows that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception,” stated the text.

However, the Catholic church remains clear that on the whole, it opposes the concept of changing one’s biological gender.

Pope Francis has been more open to LGBT issues than previous pontiffs. He has welcome a community of transgender women to his weekly general audiences, and also  signed off on a Vatican document permitting trans people to be godparents.