Dermatology: Practical and Conceptual


Opinion | Dermatol Pract Concept. 2024;14(2):e2024128 1

There Exist Educational Deficiencies in Specialized 
Dermatologic Care: Implications for Patients 

of Different Sexes, Genders, and Sexual Orientations
Isabella Mark1, Michael J. Diaz1, Jasmine T. Tran2, Shari R. Lipner3

1 College of Medicine, University of Florida, Gainesville, Florida, USA

2 School of Medicine, Indiana University, Indianapolis, USA

3 Department of Dermatology, Weill Cornell Medicine, New York City, USA

Key words: residency, education, specialty care, genital dermatology, gender-affirming care, LGBTQIA+

Citation: Mark I, Diaz MJ, Tran JT, Lipner SR. There Exist Educational Deficiencies in Specialized Dermatologic Care: Implications 
for Patients of Different Sexes, Genders, and Sexual Orientations. Dermatol Pract Concept. 2024;14(2):e2024128. DOI: https://doi 
.org/10.5826/dpc.1402a128

Accepted: January 17, 2024; Published: April 2024

Copyright: ©2024 Mark et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None. 

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication. 

Corresponding Author: Michael J. Diaz, College of Medicine, University of Florida, Gainesville, Florida, USA. E-mail: michaeldiaz@ufl.edu

To the Editor, 

Current approaches to specialized dermatologic care for 

patients across sexes, gender identities, and sexual orienta-

tions are hindered by notable deficiencies in educational ex-

periences for rising medical residents and attendings, which 

poses significant challenges for this population. It is crucial 

to address these shortcomings both comprehensively and 

compassionately. Creating equitable, inclusive, and cultur-

ally sensitive care environments is paramount to ensuring 

that all individuals may seek help without fear of judgment 

or discrimination.

In cisgendered male and female patients, discrepancies 

across genital dermatosis diagnoses have been partially at-

tributed to patient preferences and dermatology residents’ 

clinical experiences. In a cross-sectional multicenter study of 

729 participants analyzing gender differences in diagnosing 

genital lichen sclerosus (LS), women were more likely than 

men to obtain a referral with a correct suspected diagnosis 

of LS prior to diagnosis at the referral center (62.8% vs. 

54.8%, respectively, P=0.003) [1]. Women more frequently 

reported severe symptoms (visual analogue scale score  

6/10 or more) compared to men, including itching (39.0% 

vs. 11.0%, P<0.001), burning (31.6% vs. 9.9%, P<0.001), 

and dyspareunia (35.8% vs. 15.6%, P<0.001) [1].

Currently, there is a paucity of clinical experience in geni-

tal dermatology in the majority of medical schools, residency 

programs, and fellowships [2]. Male and female dermatol-

ogy residents exhibit differing approaches to the treatment 

of conditions such as genital LS. These differences might be 

because patients commonly prefer physicians of their same 

gender for anogenital examinations, forming potential bias 

in experience [2]. A survey-based study (n=110) reported 

that male residents (n=45) exhibited lower comfort levels in 

performing female genitalia examinations compared to fe-

male residents (n=65; P=0.001). Similarly, female residents 

reported lower comfort levels for performing male genital 



2 Opinion | Dermatol Pract Concept. 2024;14(2):e2024128

examinations compared to male residents (P<0.001) [3]. In 

this same study, on average, PGY-4 dermatology residents 

(n=31) reported greater confidence in treating and counseling 

genital LS patients compared to PGY-2 residents (n=32) [3], 

underscoring the importance of education and case exposure 

for improved care. Additionally, in a 2020 survey of derma-

tology residents (n=95) on preferences for learning about LS, 

residents reported the lowest preference for in-person expe-

riences with an LS expert (10%), compared to learning from 

lectures (24%), journal articles (19%), book chapters (18%), 

and peer discussions (17%) [4]. Moreover, the majority of 

residents reported never showing patients the exact location 

to apply topical medications, with a smaller proportion of 

male residents doing so compared to female residents (25% 

[10/40] and 42% [23/55], respectively, P=0.004) [4]. 

Individuals identifying with the LGBTQIA+ community 

require substantial and complex dermatologic care, includ-

ing both physical (e.g., genital dermatology and/or hirsutism) 

and psychosocial needs [4]. Transgender patients, especially, 

rely on dermatologist support during their transition process 

for a range of aesthetic and medical treatments [5]. However, 

patient fears of stigmatization and negative prior experiences 

with the health care system may hinder them from seeking 

medical care [6]. For example, in a survey-based study ana-

lyzing first-year medical students’ attitudes towards homo-

sexual men and women among medical students, 45.79% 

of the 2,088 heterosexual first-year medical student respon-

dents reported explicit bias and 81.51% reported implicit 

bias against homosexual individuals [7]. Currently, educa-

tion on LGBTQIA+ content is limited within the medical 

school curricula, leaving many graduates uncomfortable 

with caring for LGBTQIA+ patients. A 2012 survey-based 

study reported that 52% of the responding faculty from U.S. 

medical education institutions had no formal LGBTQIA+ 

competency training (N=69; P< 0.05) [6, 8]. Inadequate 

care or lack of access to desired procedures may result in 

illicit procedures, which may cause significant morbidity or 

mortality. For transgender women, injected substances have 

included industrial-grade silicone and automobile transmis-

sion fluid, causing serious complications, temporary or per-

manent injuries, and death [9]. 

Mitigating the complications that may arise from in-

experienced or limited access to care requires adaptations 

that encompass education and awareness. The quality of 

patient care may substantially benefit from greater clinical 

exposure to a spectrum of genders and sexualities during 

residency training. Openness to new practices and experi-

ences may support easier assimilation into proper, adaptive 

care for these individuals. Future directions include in-

creased collaboration with LGBTQIA+ organizations, cul-

tural competency training, and reassessment of curriculum 

inclusiveness.

References

1. Virgili A, Borghi A, Cazzaniga S, et al. Gender differences in gen-

ital lichen sclerosus: data from a multicenter Italian study on 729 

consecutive cases. G Ital Dermatol E Venereol Organo Uff Soc 

Ital Dermatol E Sifilogr. 2020;155(2):155-160. doi:10.23736 

/S0392-0488.17.05819-9

2. Kuraitis D, Murina A. Gender discordance of genital exam-

ination experiences among dermatology residents and attend-

ings. J Am Acad Dermatol. 2022;86(3):638-640. doi:10.1016 

/j.jaad.2021.02.006

3. Kuraitis D, Stumpf B, Murina A. Discrepancies by dermatology 

resident gender in diagnostic confidence and management of 

 female and male genital lichen sclerosus. Dermatol Online J. 2020; 

26(7):13030/qt09r2d0n3.

4. Boos MD, Yeung H, Inwards-Breland D. Dermatologic care of 

sexual and gender minority/LGBTQIA youth, Part I: An update 

for the dermatologist on providing inclusive care. Pediatr Der-

matol. 2019;36(5):581-586. doi:10.1111/pde.13896

5. Dhingra N, Bonati LM, Wang EB, Chou M, Jagdeo J. Medical 

and aesthetic procedural dermatology recommendations for 

transgender patients undergoing transition. J Am Acad Derma-

tol. 2019;80(6):1712-1721. doi:10.1016/j.jaad.2018.05.1259

6. Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Derma-

tologic care for lesbian, gay, bisexual, and transgender persons: 

 Terminology, demographics, health disparities, and approaches 

to care. J Am Acad Dermatol. 2019;80(3):581-589. doi:10.1016/j 

.jaad.2018.02.042

7. Burke SE, Dovidio JF, Przedworski JM, et al. Do Contact 

and Empathy Mitigate Bias Against Gay and Lesbian People 

Among Heterosexual First-Year Medical Students? A Report 

From the Medical Student CHANGE Study. Acad Med J Assoc 

Am Med Coll. 2015;90(5):645-651. doi:10.1097/ACM.0000 

000000000661

8. Khalili J, Leung LB, Diamant AL. Finding the perfect doctor: 

identifying lesbian, gay, bisexual, and transgender-competent  

physicians. Am J Public Health. 2015;105(6):1114-1119. 

doi:10.2105/AJPH.2014.302448

9. Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Derma-

tologic care for lesbian, gay, bisexual, and transgender persons: 

Epidemiology, screening, and disease prevention. J Am Acad 

 Dermatol. 2019;80(3):591-602. doi:10.1016/j.jaad.2018.02.045