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Looking at and talking about genitalia: understanding where physicians and patients get their ideas about what's normal and what isn't
  1. Katrina Karkazis
  1. Correspondence to Katrina Karkazis, Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA 94305-5417, USA; karkazis{at}

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The papers in this issue by Wall and Howath and colleagues provide a much-needed focus on the ways in which images of genitalia carry implicit messages about what is normative and thus acceptable (see articles on pages 75 and 80).1 2 By construing the normal and abnormal, these authors argue, genital images shape self-perception and social attitudes about genitalia and, in so doing, the extent to which physicians and women problematise certain genitals and thus play an important role in decisions about the necessity or appropriateness of elective genital surgery.

Wall focuses her attention on the way in which medical illustrations in textbooks, atlases and patient-education materials construct what is understood as abnormal genitalia in the case of children with intersex conditions (or disorders of sex development). Conditions, she notes, “that overwhelmingly turn on visual manifestations of sex”.1

Drawing a distinction between norm as average and norm as ideal, Wall argues that all too often these two norms are conflated, and the average is upheld as the ideal. This is in part a function of the nature of medical illustration itself: a generalised representation must be depicted in one or two illustrations leading illustrators to flatten the range of human variation. Although seemingly descriptive and transparent, these illustrations impart not what is, but what ought to be. Genital images are important not simply because they shape ideas, but because those ideas—in subtle and not so subtle ways—drive treatment practices. Images that we uncritically read …

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