‘Is something wrong with mine?’: exploring perceptions and implications of (un)representative anatomy illustrations among college students of colour

Exposure to representative imagery, or a lack thereof, has mental and physical health impacts including limiting or expanding a person's beliefs about possibilities for themselves and those with shared identities. We previously conducted a content analysis of 182 anatomical illustrations from eight college-level human sexuality textbooks, finding only 12.6% of images represented medium skin tones and 1.1% of images represented dark skin tones. Building upon these findings, we held four focus groups with 19 college students of colour at a US university to examine students' beliefs about existing anatomical illustrations from human sexuality textbooks. We then conducted two follow-up focus groups where we shared commissioned illustrations reflecting greater diversity in skin colour, body types, and body characteristics. Data were analysed using thematic analysis. Three themes were generated from the focus groups: 1) implications of skin tone bias and white normativity; 2) harmful impacts of idealistic and unrepresentative body portrayals on self-esteem and body image; and 3) positive impacts of representative and inclusive imagery. Our findings demonstrate how unrepresentative images have adverse implications for mental wellbeing and body image, while sustaining structural injustices. Including more representative images within educational materials could positively impact self-esteem, body image, and belonging for students.