Despite the two “standard” versions of a penis and vulva/vagina prevalent in textbooks, genitals come in all shapes, sizes, and colors; they also change over time! These limited and oft repeated reinforce the gender/sex binary, images erase the existence of trans and intersex people, and fail to represent the vast majority of genitals. Limited representation has real consequences in healthcare so it’s especially dangerous that medical illustrations have historically promoted beauty as equivalent to health, and vice versa.
While the gender/sex binary is a recent construction, there is nothing new about assumptions on sex differences. For many centuries, the scientific consensus was that all possess the same fundamental reproductive structures, just in different arrangements. Sex was contiguous along a spectrum; for example, the vagina was merely an inverted penis, as depicted in this image by da Vinci. Medical imagery has always played a role in upholding biased misconceptions about sex differences.
Why does this matter? In medicine, what makes someone sick is having a disorder or disease, which is defined as any difference from the expected norm. By asserting that females are inherently different from males (the norm), anyone other than a male is essentially treated as having a medical condition. If difference makes disease, then anyone outside of the “standard human” could be and often is pathologized.
To paraphrase Anne Fausto-Sterling, any age’s understanding of the biology of sex and gender has been shaped by the culture that produced it. It is therefore no surprise that paradigm shifts of the Scientific Revolution provided so-called “biological proof” of fundamental dissimilarities based on sex, race, and other physical characteristics that could be exploited to preserve the social hierarchy. By having “scientific evidence” claiming of innate differences defining “superior” and “inferior” groups, Western societies were able to disenfranchise many and justify patriarchy, capitalism, colonialism, and white supremacy. Men and women were now considered opposites with natural, complementary roles in life, cementing socially-applied gender roles to biological characteristics of sex. And thus, females and males went from essentially the same but different to entirely dissimilar with some commonalities.
Not much has changed since. The vast majority of medical textbooks in the US, UK, and Canada nearly-exclusively depict white, tall, thin, able-bodied, males with People of Color and females being represented by small insets, if at all. This fails to represent over 85% of the entire population accurately — including most white males! The lack of representation of those assigned female at birth extends far beyond medical illustration, as female humans, lab animals, and even cells are routinely left out of scientific testing.
When females are depicted in medical illustration, what do you typically see? The same Eurocentric beauty standards and sexy poses you see in magazines. These images highlight symmetrical breasts, wide hips, small hands and feet, narrow waists, short stature, etc. Such characteristics tend to be more pronounced when the female figure is depicted next to a male, who is typically hypermasculinized.
Some examples of normativity in sex anatomy include:
- Genitals tend to be drawn in shades of pink
- Diminutive and symmetrical labia with undersized or absent clitoris
- Penises that are uncommonly large, straight, and circumcised yet scar-less.
- Perfectly hemispherical, symmetrical, small, perky breasts with erect nipples
- Absence or merely decorative application of wispy pubic hair
- Widespread erasure of intersex and transgender bodies, anatomy, and sexual functioning
- If images of intersex bodies are included, they are often exploitative de-identified patient photos and/or overly simplified and adult-ified infant genitals
- If trans bodies are included, they are generally confined to pre/post-surgical de-identified patient photos
- “Pink” genitals represent a minority of the population and it not representative of most skin tones; all genitals have areas that are darker and lighter
- More than 50% of people with labia have inner lips that extend below the outer ones; it’s common for one labial lip to be longer/larger than the other
- The average flaccid penis length is 3.61 inches
- It is very common for penises to have a curvature, as well as vary in thickness, particularly for people with a hypospadia
- Circumcision is extremely common in the West, but medical illustrations rarely depict surgical scarring or uncircumcised penises
- Breasts, nipples, and areolas are all unique and rarely symmetrical
- Most bodies produce pubic hair after puberty and it can range from centralized to the mons pubis to the perineum but often extends outwards
- Intersex people are rarely depicted
- Transgender people, who rely on the medical system for basic identity expression, often have to teach providers about trans care because of a lack of presentation in medical education and rely on anecdotal resources for information about what visual changes to expect from hormones
*Note, use of “female” and “male” refers to one’s sex assigned at birth; these terms include those who are cis, trans, non-binary, and intersex
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