背景:视觉图像已用于教育医疗保健提供者,病人,以及女性生殖器切割(FGC)类型学和重建程序的非专业公众。然而,文化包容,多样化,缺乏具有FGC生活经验的女性所了解的外阴的解剖学准确表示。
目的:我们寻求将世界卫生组织(WHO)FGC类型学应用于由图形艺术家设计的特定类型视觉图像的开发,并由具有FGC生活经验的女性在文化上了解FGC相关护理的健康专家小组。
方法:经过3年的过程,视觉艺术家使用基于社区的迭代方法,在不同的WHO类型和亚型中创建了带有和不带有FGC的外阴的水彩画。拥有FGC生活经验的索马里妇女与FGC相关护理的临床医生专家团队一起工作。妇女和临床医生提供了关于肤色变化的描述性输入,纹理,和肤色,以及进行生殖器检查所需动作的视觉描绘。
结果:一系列描述WHOFGC类型的外阴解剖插图。
结果:FGC类型和亚型与文化上知情的描述符和临床珍珠一起说明,以加强提供者在FGC识别和记录方面的能力WHO类型学,以及促进患者教育,咨询,共同决策,和关心。
结论:确保种族的公平代表性,性别,年龄,身体类型,医学插图的能力可以增强病人的教育,咨询,以及医疗和/或外科护理中的共同决策。FGC提供了一个镜头,通过该镜头,纳入患者知情和文化相关的图像和描述符可以增强提供者在护理受FGC影响的妇女和青少年方面的能力。
■本研究的优势包括通过基于社区的迭代过程开发视觉图像,该过程使具有FGC生活经验的女性与具有FGC相关护理专业知识的临床医生参与进来,以及解剖文献中历史上代表性不足的身体的表现。研究的局限性包括缺乏对FGC所有可能形式或做法的概括性,因为侧重于一个地理上不同的移民社区,以及由于采用基于社区的方法而无法临床验证FGC状态,因此依赖自我报告。
结论:患者知情和具有文化代表性的外阴视觉形象对于提供以患者为中心的性健康护理和教育至关重要。通过这种社区参与的工作开发的插图可能会为视觉教育内容的未来发展提供信息,从而促进了医学插图多样化表现的公平性。
Visual imagery has been used to educate healthcare providers, patients, and the lay public on female genital cutting (FGC) typology and reconstructive procedures. However, culturally inclusive, diverse, and anatomically accurate representation of vulvas informed by women possessing lived experience of FGC is lacking.
We sought to apply World Health Organization (WHO) FGC typology to the development of type-specific visual imagery designed by a graphic artist and culturally informed by women with lived experience of FGC alongside a panel of health experts in FGC-related care.
Over a 3-year process, a visual artist created watercolor renderings of vulvas with and without FGC across varying WHO types and subtypes using an iterative community-based approach. Somali women possessing lived experience of FGC were engaged alongside a team of clinician experts in FGC-related care. Women and clinicians provided descriptive input on skin color variation, texture, and skin tone, as well as the visual depiction of actions necessary in conducting a genital examination.
A series of vulvar anatomic illustrations depicting WHO FGC typology.
FGC types and subtypes are illustrated alongside culturally informed descriptors and clinical pearls to strengthen provider competency in the identification and documentation of FGC WHO typology, as well as facilitate patient education, counseling, shared decision making, and care.
Ensuring equitable representation of race, gender, age, body type, and ability in medical illustrations may enhance patient education, counseling, and shared decision making in medical and/or surgical care. FGC provides a lens through which the incorporation of patient-informed and culturally relevant imagery and descriptors may enhance provider competency in the care of FGC-affected women and adolescents.
The strengths of this study include the development of visual imagery through an iterative community-based process that engaged women with lived experience of FGC alongside clinicians with expertise in FGC-related care, as well as the representation of historically underrepresented bodies in the anatomical literature. Study limitations include the lack of generalizability to all possible forms or practices of FGC given the focus on one geographically distinct migrant community, as well as the reliance on self-report given the inability to clinically verify FGC status due to the community-based methodology employed.
Patient-informed and culturally representative visual imagery of vulvas is essential to the provision of patient-centered sexual health care and education. Illustrations developed through this community-engaged work may inform future development of visual educational content that advances equity in diverse representation of medical illustrations.