Anatomy textbooks don't address the diversity in appearance of female genitalia

To meet society’s needs, medical education in Australia requires an inclusive, gender-aware curriculum. Current anatomy textbooks are missing relevant information.

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A review of 78 anatomy textbooks, including several used in Australian medical schools, found that none of the books covered the normal variation in the appearance, size or asymmetry of female genitalia.

Associate Professor Jenny Hayes and Professor Meredith Temple-Smith examined four contemporary textbooks and multiple editions of four historical textbooks that were published between 1828 and 2021. In particular, they looked at how the books described and illustrated the vulva – the part of the female genitalia that includes the vaginal opening, the inner and outer labia, and the clitoris.

Providing medical graduates with accurate information about normal genital appearance is increasingly important, particularly as demand for female genital cosmetic surgery grows and more transgender people undergo hormone treatment and surgery.

The researchers found that vulval diversity is poorly represented in the textbooks. Most of the books include only a single image of the vulva, often a black and white line drawing. One of the textbooks, Last’s Anatomy, has no image of the vulva at all.

Some of the current textbooks feature images or photographs in which the inner labia protrude beyond the outer labia. The researchers found that in most cases, the accompanying text does not discuss labial protrusion or mention that variation in labial size and symmetry is normal. Recent editions of Gray’s Anatomy instead refer to specific anatomical variations in the labia that are rare or found only in babies or post-menopausal people.

The researchers argue that by failing to give medical graduates a realistic view of the normal variation in female genital appearance, these textbooks are not preparing healthcare professionals for all aspects of patient care.

Next steps

The researchers are interviewing 31 anatomists in Australia to find out whether and how genital anatomy is included in medical anatomy curricula.

Funding

Australian Government Research Training Program

Publication

Hayes JA, Temple-Smith MJ (2022) New context, new content – Rethinking genital anatomy in textbooks. Anatomical Sciences Education 15(5): 943–956. doi: 10.1002/ase.2173

Banner image: 'The Three Graces', sculptor unknown. (Open access image from the Metropolitan Museum of Art, NYC USA).

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