ROME — A new Vatican document expresses a negative view of elective plastic surgery for women, warning that procedures such as facelifts and tummy tucks can become a form of “aggression” that threatens female identity.

Surgical alterations in appearance, the document says, can “amputate the expressive possibilities of the human face, which are so connected to empathic abilities,” and “can be aggressive toward the feminine identity, showing a refusal of the body.”

The text suggests that elective plastic surgery may reflect the stress many women feel about their bodies, which sometimes result in “pathologies” such as eating disorders, depression, and dysmorphic disorders.

The skeptical note on plastic surgery is part of an analysis of challenges facing women today, both in society and in the Church, prepared by a panel of female consultants to the Vatican’s Pontifical Council for Culture.

The document is intended to serve as a discussion guide for the council’s upcoming Feb. 4-7 plenary assembly, which will be devoted to women’s issues. The council is led by Italian Cardinal Gianfranco Ravasi.

The document concedes that despite abundant rhetoric on the importance of women, to date they have largely been excluded from leadership roles in the Church.

“Why, with their great presence, have women had so little impact on the Church’s structures?” it asks. “In pastoral praxis, why are we giving women only those tasks of a somewhat rigid scheme, the fruit of ideological and ancestral left-overs?”

The document acknowledges that women work as top managers in other walks of life, but often have no corresponding decision-making role or responsibility within their Christian communities.

“If, as Pope Francis says, women have a central role in Christianity,” says the document, “this role must find a counterpart also in the ordinary life of the Church.”

Among other topics, the document explores the role of women in the professional arena, violence and exploitation of women, the female body, and “generativity” as a key to understanding female distinctiveness.

The text explores each issue and poses a set of questions, such as “Where are the roots [of the radical inequality between men and women]?” and “Why are women killed by a husband, fiancé, partner or ex-partner after years of life together?”

When it comes to the female presence in the Church, the outline document says that “there’s no discussion here of women priests, which according to statistics is not something that women want.”

But the document does highlight the fact that the image of womanhood that the Church has does not correspond to reality.

“Today women no longer spend their afternoons reciting the rosary or taking part in religious devotions,” says the document.

The document says men and women are different in how they solve problems, view the environment, and even rest, and that canceling these differences impoverishes personal experience.

“It is right not to accept an imposed neutrality but to value difference,” it says.

Quoting the Second Vatican Council, the document warns against the loss of the feminine as a result of women’s presence in a society that is markedly masculine.

“It is with respect to this originality of women that the true development of the feminine position will develop,” it says.

The document highlights the role of women in generating life, since “the body of the woman is the starting point of each human person.”

“Is there sufficient recognition of the value of women in this indispensable segment of human life?” the document asks. If this sort of caregiving work is still a women’s role, the text adds, is it given adequate economic recognition?

The document also calls for a clear commitment to fighting domestic violence, describing it as the main cause of death in the world for women aged between 16 and 44.

It also lists selective abortion, infanticide, genital mutilation, crimes of honor, forced marriages, trafficking of women, sexual molestation, and rape as “some of the deepest injuries inflicted daily on the soul of the world, on the bodies of women and of girls, who become silent and invisible victims.”

The Council for Culture is scheduled to hold a news conference Feb. 2 to provide an overview of its discussion on women. Among the presenters will be Nancy Brilli, a well-known Italian actress who appeared in a controversial YouTube video asking women around the world to submit messages for the plenary assembly.

In the English version of the video, some found Brilli’s performance as stereotypically coquettish, producing a backlash that led to its removal.

Ravasi, who spoke with Crux in early January, said he saw the video as an experiment in crowd-sourcing, but looking back, he said, “I understand now we probably made a mistake with the actress.”

That said, Ravasi takes pride in the fact that video input from women around the world will be part of the opening public event of the plenary assembly, to be staged in a Roman theater Feb. 4. Women from around the world are invited to participate through social media with #lifeofwomen.