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Visual Representation of Vulvar Skin Conditions in Major Gynecology Textbooks: Are Skins of Color Underrepresented?
Purpose: To evaluate images of vulvar conditions (VCs) in major
gynecologic textbooks and determine whether there is diverse representation of
Background: Familiarity with the appearance of vulvar pathology on
different skin tones is critical for obstetrician/gynecologists (ObGyns) to
skillfully and equitably identify and treat VCs.
Methods: Images of VCs in gynecologic textbooks for medical
students, ObGyn residents, and fellows were compiled. Skin tones were scored
according to the Fitzpatrick Scale (FS) and categorized as benign,
infectious/inflammatory, dysplastic, or cancerous. Publishing and author
demographics were collected.
Results: Of 512 images from 21 textbooks, 75% [Nf 395]
were of lighter skin tones (FS I-III). VCs were represented on darker skin (FS
VI) in 19.6% of images in texts targeting residents, compared to 8.5% and 4.5%
in fellow and student textbooks, respectively (p < .001). Compared to a
cornerstone surgical atlas, the pediatric and adolescent gynecology text
consisted of lighter skin tones (OR 0.59, CI 0.35-0.98), and a prominent
general gynecology text used darker skin tones (OR 2.97, CI 1.51-5.83). Images
of inflammatory/infectious conditions were more likely to be of darker skin
tones (p = 0.010).
Discussions: Most textbook images of VCs represent lighter skin
women, and darker skin tones are particularly underrepresented in texts geared
towards fellows and students. Inadequate exposure to VCs\' appearance on darker
skin may promote racial inequities in healthcare. Medical textbooks should aim
to present visually diverse images of vulvar pathologies to train physicians
well versed in caring for patients of all skin tones and promote health equity
for all patients.
CREOG & APGO Annual Meeting, 2021, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Patient Care, Medical Knowledge, Practice-Based Learning & Improvement, GME, CME, UME, Lecture, Gynecologic Oncology, Pediatric & Adolescent Gynecology, Reproductive Endocrinology & Infertility, Female Pelvic Medicine & Reconstructive Surgery, Infectious Disease,