Introduction: Self-identification with images portrayed in patient-facing education materials aids in understanding medical conditions, especially with sensitive topics such as erectile dysfunction (ED). Previous data have shown underrepresentation of minority men in other urologic online content. The current study is designed to assess racial, ethnic, and sexual orientation diversity depicted on academic urology ED websites. Methods: Websites of the top academic urology departments from U.S. News & World Reports 2022 rankings were reviewed as sources of high quality content. All subpages were reviewed to identify ED and men’s health sites with extraction of photo and video imagery depicting human subjects. A three-person review team interpreted race, ethnicity, and sexual orientation categorically and using a numeric scale, Fitzpatrick skin rating. Median Fitzpatrick ratings were classified as white (1-3) or non-white (4-6). Consensus ratings were summarized descriptively, Spearman’s rank correlation used for interrater reliability of Fitzpatrick ratings, and MedCalc’s z-tests used to compare diversity proportions to national rates. Results: The top 31 ranked academic urology websites were reviewed to exclude non-academic centers. Over a third of reviewed sites did not contain any human images (12/31, 38.7%). A total of 85 images were collected. Race in the 74 (87.0%) interpretable images included 5 (6.8%) Asian, 12 (16.2%) black, 52 (70.3%) white, and 5 (6.8%) other men. Latino men were represented in 3 of 47 (6.4%) images. Utilizing Fitzpatrick ratings, 70 (82.4%) subjects were classified as white and 15 (17.6%) non-white. Most images [46 (54.1%)] demonstrated a man without a partner. Of those with a partner where sexual orientation could be determined, 20 (90.9%) were heterosexual and 2 (9.1%) homosexual. Between reviewer correlation coefficients for Fitzpatrick ratings ranged from 0.68-0.71. Table 1 compares interpreted image data to population benchmarks. Conclusions: Limited imagery on academic urology ED websites, while displaying modest racial diversity, continues to underrepresent some groups, namely Latinos. Although men in homosexual relationships were depicted, the absolute number of such images was low. Conscious effort to improve diversity in online male sexual dysfunction content is needed. SOURCE OF Funding: Hartford HealthCare Health Equity Grant
