The Vatican issued a declaration on Monday claiming that gender-affirming surgeries risk threatening “the unique dignity” of people, further criticizing “gender theory” and rejecting attempts to obscure the “sexual difference between man and woman.”

The document from the Vatican’s doctrinal office titled “Dignitas Infinita”—Latin for “Infinite Dignity”—also reaffirmed the faith’s opposition to abortion and euthanasia. It comes as Pope Francis has faced an intense conservative backlash to recent liberalizing measures including allowing Catholic priests to bless same-sex couples.

In a brief section on “Sex Change,” the declaration cites Francis’ view that “creation is prior to us and must be received as a gift,” adding that “we are called to protect our humanity, and this means, in the first place, accepting it and respecting it as it was created.” It therefore follows, the declaration reads, “that any sex-change intervention, as a rule, risks threatening the unique dignity the person has received from the moment of conception.”

It it appeared to be condemning specific kinds of gender-affirming operations but explained that a person born with “genital abnormalities” may choose to “receive the assistance of healthcare professionals to resolve these abnormalities,” and such assistance would “not constitute a sex change” that would risk threatening dignity.