TABLE 1.

Summary of textbook analysis

Textbook	Index	Image	Description	Remit from preface
Gray's Anatomy 42 editions 1858–2021 (40 editions analyzed) Davies and Davies (1962) Davies and Coupland (1967) Gray and Carter (1858, 1860) Holmes (1864, 1869, 1872, 1875, 1877) Howden (1909, 1913, 1916, 1918, 1920, 1923, 1926) Johnston (1930, 1932, 1935) Johnston and Whillis (1938, 1942, 1946, 1949, 1954) Johnston et al. (1958) Pick (1883, 1887, 1890, 1893, 1897) Pick and Howden (1901, 1905) Standring (2005, 2008, 2015, 2021) Warwick and Williams (1973) Williams (1989, 1995) Williams and Warwick (1980)	Vulva and all its component structures indexed Normal and (anatomical) variation not indexed Erection and ejaculation indexed, but not orgasm	Single black‐and‐white line drawing in editions 1–39 Clitoris diminished in size in 13th edition Labeling of clitoris reduced, and labia minora diminished in size in 18th edition Multipart color illustration with photos introduced in 40th edition	Heavily detailed descriptive text with minimal change between editions 1–37 Labium tertium added in 38th edition Changes with aging added in 39th edition Homology removed in 40th edition Adhesions between labia minora added in 41st edition Severe atrophy in postmenopausal females added in 42nd edition	To provide the student and practitioner with an accurate view of the anatomy of the human body and its application to practical surgery
Cunningham's Textbook of Anatomy 12 editions 1902–1981 (12 editions analyzed) Cunningham (1902, 1905, 1909) Robinson (1913, 1918, 1931) Brash and Jamieson (1937, 1943) Brash (1951) Romanes (1964, 1972, 1981)	Vulva and all its component structures indexed Normal and (anatomical) variation not indexed	Same black‐and‐white line drawing in all 12 editions	Heavily detailed descriptive text with minimal change between editions No mention of diversity, protrusion, or function	For undergraduate students but also for postgraduate studies
Quain's Elements of Anatomy 11 editions 1828–1914 (4 editions analyzed) Quain and Sharpey (1848) Sharpey et al. (1882) Sharpey and Thane (1890) Schäfer et al. (1908)	Vulva and all its component structures indexed Normal and (anatomical) variation not indexed, but “varieties” is a subheading under “vulva” in 11th edition (Schäfer et al., 1908)	Variable black‐and‐white line drawing	Description of labial protrusion and changes with aging added to 11th edition (Schäfer et al., 1908) Separate paragraph on varieties seen in external female genitalia added to 11th edition (Schäfer et al., 1908)	Not specified
Buchanan's Manual of Anatomy 8 editions 1906–1950 (5 editions analyzed) Buchanan (1906) Barclay‐Smith et al. (1925) Frazer (1937) Wood Jones (1946, 1949)	The term “vulva” not indexed, but all of its component structures indexed Normal and (anatomical) variation not indexed	Black‐and‐white line drawing (possibly sourced from Gray's Anatomy)	Description of labial protrusion in all editions Hottentot apron referenced in editions 1–6, then removed from future editions	A guide to the structure of the human body as it is revealed in the process of dissection
Last's Anatomy 12 editions 1959–2011 (7 editions analyzed) Last (1959, 1984) McMinn (1990, 1994) Sinnatamby (1999, 2006, 2011)	Labia not included in the index until 8th edition (McMinn, 1990); vulva not included until 10th edition (Sinnatamby, 1999) Normal and (anatomical) variation not indexed Erection, ejaculation, and orgasm– male and female –indexed	No image in any edition	Homology between female and male structures included in editions 1–7 The term vulva and a list of female external genitalia included from 8th edition (McMinn, 1990) onwards Reference to labia minora in paragraph on female orgasm included in editions 8–11, then removed	For students in basic and higher surgical training programs and for practicing surgeons
Moore's Clinically Oriented Anatomy 7 editions 1980–2014 (7 editions analyzed) Moore (1980, 1985, 1992) Moore and Dalley (1999, 2006) Moore et al. (2010, 2014)	Vulva and all its component structures indexed Normal not indexed Anomoly (arteries/bones/ muscles/nerves/other) indexed in 1st and 2nd editions, then removed in 3rd edition Anatomical variation indexed and defined/described in editions 4–7 Erection indexed (relates to penis); ejaculation and orgasm not indexed	Black‐and‐white line drawing and dissection drawings (from Grant's Atlas of Anatomy) in editions 1–3 Line drawing changed to color in 4th edition (Moore & Dalley, 1999); dissection drawings changed to color in 5th edition (Moore & Dalley, 2006) Multipart illustration of vulva in editions 6 and 7, including three photos of a vulva with labia minora protruding beyond the labia majora	Description of labial protrusion in editions 1–3 List of functions included in 4th edition (Moore & Dalley, 1999) onwards, but reference to labial protrusion removed	For health science students
Gray's Anatomy for Students 4 editions 2005–2020 (3 editions analyzed) Drake et al. (2005, 2015, 2020)	The term “vulva” is not indexed, but all of its component structures are Normal and (anatomical) variation not indexed Erection (of penis and clitoris) indexed	Color line drawing (overview and close‐up), with the labia labelled Three color photos show visible labia minora	Vulva/labia described in two separate areas of the text: regional anatomy and surface anatomy No mention of diversity, protrusion, or function	For students in a variety of professional programs (medical, dental, chiropractic, and physical therapy)