Fruit-Based Women's Health Simulation Training: A Not So Sweet Reality

Authors: Christine Goudie, MDes, PhD Student & Rebecca Wytsma, B.Eng.
Reviewed by Crystal Northcott, MN, NP
September 2, 2025

From avocados to oranges, using fruit to simulate female anatomy might seem clever, but in women’s health, clever is not enough. When better tools exist, settling for stand-ins sends the wrong message: that women’s bodies are not worth the investment.

I recently told a friend about a research paper I came across, where medical residents rehearsed IUD insertions on avocados, which were supposed to represent women’s uteri. At first, she responded with, “That’s cool and creative.” 

Then I asked her, “Would you feel comfortable having an IUD inserted by someone who has only ever practiced on an avocado?” The look on her face said it all.

The Early Seeds of the Practice

Throughout history, fruit has been used to symbolize female reproductive anatomy. The fig was a common symbol used in ancient Greek and Roman mythology, while the pomegranate became an emblem of fertility in Renaissance art. Over time, this symbolic imagery evolved from classical paintings to modern digital shorthand such as the peach emoji. 

The metaphor also took on a more literal dimension: what once served as artistic symbolism began to inspire medical practice. Recognizing the physical similarities, practitioners started using fruit not just to symbolize anatomy, but to simulate it. With soft textures, some fruits naturally mimic the tactility of certain body parts and tissues, though they fall woefully short in terms of visual accuracy.

The Pit-Falls of Fruit in Women’s Health Research

Fruit has been used as an accessible simulation tool in various areas of medicine, including banana peels for suturing practice and clementines for laparoscopic training. However, there appears to be a notable concentration of research focused on the use of fruit in women’s health simulation.

Fruit for Women’s Health Simulation

A quick internet search reveals several research studies that have explored the use of fruits as anatomical models for gynecological procedures. These include avocados and banana peppers to simulate the uterus for IUD insertion, eight different fruits (including papayas and dragon fruit) for modelling the uterus during uterine aspiration, unripe bananas to represent the cervix for tenaculum placement, and oranges and grapefruits as stand-ins for the cervix during dilation and effacement. 

While the existence of such studies might not come as a surprise, their recency might: all were published in the last decade, with two of the studies published as recently as 2024. 

Fruit for Men’s Health Simulation

Another interesting observation? The relative scarcity of research on the use of fruit in men’s health simulation. The classic image of a banana in junior high health class may come to mind when thinking of fruit in this context. However, beyond that trope, there appears to be limited scholarly work exploring fruit as a tool for simulating medical procedures involving male anatomy. 

Sprouting Solutions

Our intent is not to diminish the value of research studies conducted using fruit. In resource-limited settings, fruit can provide a practical, low-cost alternative for procedural training. However, the above-mentioned studies all originated in the United States and Canada, two global leaders in healthcare research and medical innovation. So, the question becomes: In 2025, shouldn’t there be better tools for women’s health simulation?”

The fact is, better tools than fruit do exist. Anatomical models and simulators have seen extraordinary advancement in recent decades. Medtech companies have developed high-fidelity simulation models with lifelike anatomy, mechanical motion, fluid simulation, sensory feedback, and realistic skin and tissue texture. Though some of these devices - particularly full-body manikins intended for use in medical schools - are cost-prohibitive for the average practitioner and clinic, there are many realistic training tools on the market that are both high quality and affordable.

A Ripe Opportunity

Ultimately, in settings where it is feasible and affordable to invest in accurate simulation tools, such investments should be made. Women’s health has long been underfunded and under-researched, and relying on makeshift tools, like fruit, to simulate female anatomy when better resources are available, falls short in promoting the advancement of women’s health.

Perhaps it is time to let the fruit symbolism rot, and to plant seeds for a future where practitioners are trained in women’s health using anatomically-appropriate training models. Such models should be reflective of the complexity and gravity of the procedures being taught, especially as it pertains to the patients’ safety and long-term well-being.

Granville Biomedical was founded in 2019 to address discrepancies in accurate and affordable training tools in women’s health. The company has since developed trade secret silicone recipes that replicate skin and tissue texture. Granville Biomedical® models enable practitioners to rehearse procedures, offering lifelike accuracy in both texture and appearance. In addition to the Venus and Iris models, which can be used to demonstrate procedures such as pelvic floor techniques, pap smears, and pessary insertion, the company is continually working to expand its product line to accommodate a greater number of women’s health procedures.

References

[1] D. Jegen et al., “Avocados as simulation tools for intrauterine device insertion and removal,” Can. Fam. Physician, vol. 70, issues 7-8, pp. 476-478, Jul./Aug. 2024, doi: 10.46747/cfp.700708476.

[2] K. Wong et al., “Banana fruit: An “appealing” alternative for practicing suture techniques in resource-limited settings,” Am. J. Otolaryngol., vol. 39, issue 5, pp. 582-584, Sep./Oct. 2018, doi: 10.1016/j.amjoto.2018.06.021.

[3] P. Andreatta et al., “Low-hanging Fruit: A Clementine as a Simulation Model for Advanced Laparoscopy”, Simul. Healthc., vol. 9, issue 4, pp. 234-240, Aug. 2014, doi: 10.1097/SIH.0000000000000032.

[4] A. Holland, “Using simulation to practice IUD insertion and removal techniques,” Womens Healthcare, vol. 7, no. 2, pp. 32-38, Jun. 2019, Available: https://www.npwomenshealthcare.com/digital/June2019/#page=31

[5] S. Owens, S. Kaur, and A. Henkel, “Utilising fruits to enhance first-trimester abortion simulation: can we do better than a papaya?” BMJ Sex. Reprod. Health., vol. 50, issue 4, pp. 303, 2024, doi: 10.1136/bmjsrh-2024-202354.

[6] S. Webb et al., “The case for the green banana: Using fruit to improve tenaculum placement simulation”, Contraception, vol. 124, article 110061, Aug. 2023, doi: 10.1016/j.contraception.2023.110061.

[7] K. Shea and E. Rovera, “Vaginal Examination Simulation Using Citrus Fruit to Simulate Cervical Dilation and Effacement”, Cureus, vol. 7, issue 9, Sep. 2015, doi: 10.7759/cureus.314