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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 skin tones.


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% [N&#3f 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.

Topics: 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,

General Information

Student,Resident,Faculty,Clerkship Director,Clerkship Coordinator,Osteopathic Faculty,Residency Director,Residency Coordinator,
Patient Care,Medical Knowledge,Practice-Based Learning & Improvement,
Clinical Focus
Gynecologic Oncology,Pediatric & Adolescent Gynecology,Reproductive Endocrinology & Infertility,Female Pelvic Medicine & Reconstructive Surgery,Infectious Disease,

Author Information

Anwei Gwan, MS, Louisiana State University Health Sciences Center; La\'Nasha Tanner-Sanders, MD; Andrew Chapple, PhD; Navya Nair, MD,MPH; Amelia Jernigan, MD

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