Anatomy Textbooks ‐ Mind the Gap

Abstract

Introduction and objective The aim of this study was to determine if and how diversity and variation are represented in iconic, authoritative anatomy texts used to prepare students for contemporary clinical practice.The contemporary issue of labiaplasty, a new and increasingly commonly performed cosmetic surgery procedure, provided a focal point for this study. The anatomical criteria behind this surgery are problematic because of confusion between “normal labia” and “idealised labia”.1 Valid and accurate information about normal labial diversity is critical to referring practitioners and the gynaecologists and plastic surgeons performing these procedures. Materials and method A sample of historic, multiple edition and popular contemporary textbooks as well as the peer-reviewed literature were examined for a specific set of features to determine similarities and differences in descriptions and depictions of the labia (including information about normal structural variation and function). Results 39 of 41 editions of Gray's Anatomy, 4 of 8 editions of Buchanan's Manual of Anatomy and contemporary editions of Moore's Clinical Anatomy, Last's Anatomy and Gray's Anatomy for Students, together with over 100 peer reviewed journal articles were examined. Despite expectations that the anatomy textbooks used in medical training would be authoritative and supportive of contemporary clinical practice, they covered basic anatomy of the vulva only, and information on function, normal diversity and changes with sexual activity, childbirth and aging is not included. They do not reflect recent population data and have remained rigid and unresponsive to the concurrent proliferation of social polemics.2 Conclusion Contemporary anatomy courses using popular contemporary anatomy texts may be graduating doctors with a knowledge gap about normal genital diversity. This gap would have been less problematic in the pre-labiaplasty era but now leaves the practitioners insufficiently informed about normal female genital anatomy to competently assess and advise the increasing number of women and girls requesting labiaplasty.3 Anatomical texts and resources need to recognise normal variation and represent new evidence base so that anatomy courses support our clinical colleagues and are not merely hurdles for students to pass. References Clerico, C., Lari, A., Mojallal, A., & Boucher, F. (2017). “Anatomy and aesthetics of the labia minora: the ideal vulva?” Aesthetic Plastic Surgery, 41(3), 714-719. Hayes, J. A., & Temple-Smith, M. J. (2020). “What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy.” Australian and New Zealand Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/ajo.13298 Simonis, M., Manocha, R., & Ong, J. J. (2016). “Female genital cosmetic surgery: a cross-sectional survey exploring knowledge, attitude and practice of general practitioners.” BMJ open, 6(9).