There is a familiarity about this photo, and it could have been taken in many boardrooms around the world - men gathered around a table making plans and cutting deals.
But the lack of women here, among a group of conservative Republicans discussing their healthcare bill with the vice-president, struck a particular nerve.
That's because one of the points under discussion was whether the new bill should mandate that health insurance plans provide "essential benefits" including maternity services.
In January, the White House came in for some flak when President Trump signed an abortion order surrounded by men.
So the reaction was swift when Vice-President Mike Pence tweeted the photo, with the words: "Appreciated joining @POTUS for meeting with the Freedom Caucus again today This is it. #PassTheBill"
Democratic Senator Patty Murray was one of the first to respond, making an ironic observation.
The image also dismayed Democratic Congressman Jim McGovern, who described it as an outrage.
Others gave a numeric illustration to make their point.
One woman - a Trump adviser, Kellyanne Conway - and 28 men can be seen in another photo of Thursday's meeting, tweeted out by the president's special assistant Cliff Sims.
The president has been keen to include women in the photographs of him signing executive orders, ever since the White House was heavily crticised for an all-male photo of him legislating on abortions, on his first day in the job.
And Dan Scavino, President Trump's social media director, was quick to respond to the criticism on Thursday by tweeting a female-friendly photo of the president and his vice-president negotiating the healthcare bill with a group of moderate Republicans.
Less than a fifth of Republicans in the House of Representatives are women, but gender representation is not just a Republican problem - the US Congress as a whole is still dominated by men.
With 20% female, the US ranks alongside Bangladesh in global terms. In Sweden it's 44%.
The US is not the only country to have an all-male photograph from the corridors of power sparking debate.
Last week, an inaugural girls' council in al-Qassim province in Saudi Arabia was condemned when the first pictures showed 13 men on stage, but no women.
The disquiet over the Mike Pence photo has put the spotlight on the concessions that President Trump is offering to the conservative wing of his party, namely to strip the new health bill of "essential benefits".
Conservatives have long wanted to reverse an Obamacare requirement that all health plans include 10 key benefits, including emergency services, drug use treatment and maternity care.
It has led some people to question why they are paying for services they say they do not need - like pediatric care for people who have no intention of having children.
Republican Senator Pat Roberts expressed that view on Thursday, when asked about the negotiations, saying: "I wouldn't want to lose my mammograms."
He later tweeted an apology: "I deeply regret my comments on a very important topic. Mammograms are essential to women's health & I never intended to indicate otherwise."