Introduction

In medical and patient education, visual images play a crucial role in enhancing understanding and communication. The integration of visual elements with text has proven effective in health education, particularly in facilitating dialogue between healthcare practitioners and patients.

However, medical training may spread biases and lack diversity in visual representations, potentially impacting medical decision-making and contributing to healthcare inequalities. For example, there are unequal visual representations of different races, genders, ages, body types, and abilities in medical illustrations.

A recent study on the topic highlights the need for culturally informed and anatomically accurate visual representations of vulvas, focusing on types of female genital cutting (FGC) as a case study. The aim is to bridge gaps in clinical knowledge and promote equity in medical illustrations, especially when it comes to sexual healthcare. The authors of the study presented original watercolor illustrations of FGC subtypes, emphasizing their cultural accuracy for Somali skin tones, as a step towards more inclusive visual educational content.

Methods

This study involved a 3-year collaborative process to develop watercolor illustrations depicting FGC types. It was led by physician experts in FGC and an artist specializing in illustrations of genitalia (A.F.). The team also involved community partners, including SoLaHmo (a community-driven research organization that promotes the health of diverse communities) and a Community Advisory Board, to ensure cultural sensitivity and accuracy.

A.F. used watercolors, referenced diverse images, and underwent over 50 iterations to create nine illustrations representing FGC vulva types. The team also crafted culturally inclusive clinical pearls (small bits of relevant clinical information) for clinicians who may be less familiar with the look of the vulva after FGC.

Results

The result of the study was a collection of detailed descriptions of FGC types and subtypes, offering support for healthcare professionals around the world conducting vulvar examinations. Notably, it corrects anatomical inaccuracies in the World Health Organization's (WHO) FGC classification, clarifying that only the external clitoral glans is removed in type 1 FGC, but the body and crura of the clitoris remain.

Culturally informed descriptions accompany the illustrations of each FGC type. Descriptions highlight nuances, emphasizing psychological impact considerations and potential disagreement between patient self-report of their vulva and clinician assessment. The purpose of the study was to enhance healthcare professionals’ understanding of FGC variations and foster sensitive patient care.

Discussion & Conclusion

This study emphasizes the importance of vulvar drawings in fostering open dialogues between healthcare practitioners and patients affected by FGC. It addresses the lack of diversity in illustrations of vulvar anatomy to date, and the need for culturally sensitive visual aids to help destigmatize FGC.

The watercolor images, developed collaboratively, offer a realistic yet acceptable approach for patient discussions. The authors of the study highlighted the community-based development process, emphasizing cultural representation and inclusivity.

Nevertheless, limitations include the images’ specificity to the Somali community when other populations should also be represented in these images. As such, there is an ongoing need for racially conscious and inclusive visual representations in sexual health care which should continue to be addressed.

References:

• Chaisson, N., Johnson-Agbakwu, C. E., Finch, A., Salad, M., Connor, J. J., Chen, M., & Robinson, B. B. E. (2023). Beautiful vulvas: expanding illustrative visual imagery of female genital cutting types. The Journal of Sexual Medicine, 20(11), 1301-1311. https://doi.org/10.1093/jsxmed/qdad102