(89) Normalizing Normal: Vulvar Anatomy and Medical Education

Background: Given medical education’s focus on disease identification and investigation, it is not surprising normal variations of vulvar anatomy are frequently mislabeled as pathology. A need for improved education on this topic has been identified by medical learners. Yet, the most widely used education materials lack anatomic detail and skin of color inclusion. We explored medical students' abilities to identify normal vulvar anatomy, to discover where students access supplementary education and opportunities for curriculum enhancement.

Methods: A qualitative survey with caricatures of vulvas created by a medical illustrator was distributed by email to students at a Canadian medical school. The target sample size was 42 participants. Participation was optional, anonymous, and not reimbursed. Vulva caricatures with white skin and skin of color were used, and all depicted variations of normal anatomy. Multiple choice questions asked participants to identify if the caricature displayed normal anatomy or not, and open-ended questions asked participants to elaborate on their understanding of the topic and their educational resources. All data was descriptive, with no formal statistical analysis required. We received ethics approval by the Conjoint Research Ethics Board (REB 22-1201).

Results: 45 responses were submitted. 42% of participants were in second year medical school, 29% in first, and 29% were in third year. All vulva caricatures were correctly identified as normal by the majority of participants. There were no noted differences between participants' ability to identify normal anatomy on white skin compared to skin of color, but statistical significance was not met. 32.3% of participants identified personal experience as their primary source of education, 23.5% said clinical exposure, and 20.5% said Social Media. The most common forms of personal experience were work, art, and self-directed research. 24% of participants followed Instagram accounts dedicated to normalizing variations of vulvar anatomy and physician run accounts focused on sexual health education.

Conclusions: Personal interest and Social Media contribute significantly to medical students’ education on vulvar anatomy. This raises the concern that without a special interest learners may have gaps in their education, posing a risk to patient care. Those at the highest risk are skin of color patients, who have documented worse vulvar health outcomes due to physician inexperience. With an increasing number of learners using Social Media as a source of education; we advocate for a reform to medical education through a lens of equity and diversity, and suggest online learning tools as a method for curriculum enhancement.