Publications

Assistant Professor of Obstetrics and Gynecology and, by courtesy, of Epidemiology and Population Health

Publications

  • Sexual Wellness in Cisgender Lesbian, Gay, and Bisexual People. The Urologic clinics of North America Stark, B. A., Obedin-Maliver, J., Shindel, A. W. 2021; 48 (4): 461-472

    Abstract

    Cisgender sexual minority persons have sexual wellness needs that go well beyond disease prevention. Despite historical asymmetries in research and clinical attention to sexual wellness in cisgender lesbian, gay, and bisexual persons, a growing body of evidence exists on how to optimally care for these populations. Additional research and development is warranted.

    View details for DOI 10.1016/j.ucl.2021.06.005

    View details for PubMedID 34602168

  • Sexual Orientation Diversity and Specialty Choice Among Graduating Allopathic Medical Students in the United States. JAMA network open Mori, W. S., Gao, Y., Linos, E., Lunn, M. R., Obedin-Maliver, J., Yeung, H., Mansh, M. D. 2021; 4 (9): e2126983

    View details for DOI 10.1001/jamanetworkopen.2021.26983

    View details for PubMedID 34591110

  • From 'Shark-Week' to 'Mangina': An Analysis of Words Used by People of Marginalized Sexual Orientations and/or Gender Identities to Replace Common Sexual and Reproductive Health Terms HEALTH EQUITY Ragosta, S., Obedin-Maliver, J., Fix, L., Stoeffler, A., Hastings, J., Capriotti, M. R., Flentje, A., Lubensky, M. E., Lunn, M. R., Moseson, H. 2021; 5 (1): 707-717
  • You miss 100% of the shots you don't take: time to push boundaries in fertility care of transgender people. Fertility and sterility Moravek, M. B., Obedin-Maliver, J. 2021

    View details for DOI 10.1016/j.fertnstert.2021.06.020

    View details for PubMedID 34247760

  • Endometrial findings among transgender and gender nonbinary people using testosterone at the time of gender-affirming hysterectomy. Fertility and sterility Hawkins, M., Deutsch, M. B., Obedin-Maliver, J., Stark, B., Grubman, J., Jacoby, A., Jacoby, V. L. 2021

    Abstract

    OBJECTIVE: To describe clinical characteristics and associated endometrial findings of transgender and gender nonbinary people using gender-affirming testosterone.DESIGN: Retrospective case series.SETTING: Academic medical center and public safety net hospital.PATIENT(S): Eighty-one patients using gender-affirming testosterone therapy undergoing hysterectomy for the indication of gender affirmation from 2000 to2018.INTERVENTION(S): None.MAIN OUTCOME MEASURE(S): Preoperative clinical characteristics and endometrium surgical pathology diagnoses.RESULT(S): Median age was 31 years (interquartile range [IQR] 27-40), and median body mass index 27 kg/m2 (IQR 24-30). Six patients (7%) were parous and 60 (74%) had amenorrhea. Thirty-three patients (40%) had proliferative and 40 (50%) atrophic endometrium. Endometrial polyps were found in nine patients (11%) of the sample. Endometrial findings were similar in the subgroup of 60 patients with preoperative amenorrhea. There were no cases of endometrial hyperplasia or malignancy. In bivariate analysis, those with proliferative endometrium were found to be, on average, 5.6 years younger than those with atrophic endometrium. There were no clinical factors associated with having proliferative versus atrophic endometrium in multivariable models.CONCLUSION(S): People using gender-affirming testosterone may have either proliferative or atrophic endometrium, including people who present with amenorrhea. Further study is needed to develop evidence-based guidelines for appropriate screening for endometrial hyperplasia or cancer in this population.

    View details for DOI 10.1016/j.fertnstert.2020.11.008

    View details for PubMedID 33583596

  • Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States. BMJ sexual & reproductive health Moseson, H. n., Fix, L. n., Gerdts, C. n., Ragosta, S. n., Hastings, J. n., Stoeffler, A. n., Goldberg, E. A., Lunn, M. R., Flentje, A. n., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J. n. 2021

    Abstract

    Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

    View details for DOI 10.1136/bmjsrh-2020-200966

    View details for PubMedID 33674348

  • Online health information seeking, health literacy, and human papillomavirus vaccination among transgender and gender-diverse people. Journal of the American Medical Informatics Association : JAMIA Pho, A. T., Bakken, S., Lunn, M. R., Lubensky, M. E., Flentje, A., Dastur, Z., Obedin-Maliver, J. 2021

    Abstract

    The purpose of this study is to describe online health information seeking among a sample of transgender and gender diverse (TGD) people compared with cisgender sexual minority people to explore associations with human papillomavirus (HPV) vaccination, and whether general health literacy and eHealth literacy moderate this relationship.We performed a cross-sectional online survey of TGD and cisgender sexual minority participants from The PRIDE Study, a longitudinal, U.S.-based, national health study of sexual and gender minority people. We employed multivariable logistic regression to model the association of online health information seeking and HPV vaccination.The online survey yielded 3258 responses. Compared with cisgender sexual minority participants, TGD had increased odds of reporting HPV vaccination (aOR, 1.5; 95% CI, 1.1-2.2) but decreased odds when they had looked for information about vaccines online (aOR, 0.7; 95% CI, 0.5-0.9). TGD participants had over twice the odds of reporting HPV vaccination if they visited a social networking site like Facebook (aOR, 2.4; 95% CI, 1.1-5.6). No moderating effects from general or eHealth literacy were observed.Decreased reporting of HPV vaccination among TGD people after searching for vaccine information online suggests vaccine hesitancy, which may potentially be related to the quality of online content. Increased reporting of vaccination after using social media may be related to peer validation.Future studies should investigate potential deterrents to HPV vaccination in online health information to enhance its effectiveness and further explore which aspects of social media might increase vaccine uptake among TGD people.

    View details for DOI 10.1093/jamia/ocab150

    View details for PubMedID 34383916

  • Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender sexual minority men and women. BMC psychiatry Nagata, J. M., Compte, E. J., Cattle, C. J., Lavender, J. M., Brown, T. A., Murray, S. B., Flentje, A., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2021; 21 (1): 297

    Abstract

    Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of elevated body image-related concerns among sexual minority populations, little is known about the degree of muscle dysmorphia (MD) symptoms among sexual minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to examine the nature and severity of MD symptoms in cisgender sexual minority men and women and provide community norms of the MDDI for these populations.Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people from the United States, were examined. Participants included cisgender gay men (N = 1090), cisgender bisexual plus (bisexual, pansexual, and/or polysexual) men (N = 100), cisgender lesbian women (N = 563), and cisgender bisexual plus women (N = 507). We calculated means, standard deviations (SD), and percentiles for the MDDI total and subscale scores for cisgender sexual minority men and women. We compared MDDI scores by sexual orientation using linear regression models, both unadjusted and adjusted for sociodemographics.Overall, the sample was 85.2% White, 3.0% Asian or Pacific Islander, 2.0% Black, 0.5% Native American, 3.9% multiracial, and 6.6% Hispanic/Latino/a. The mean age was 38.6 (SD = 14.3) and 69.4% had a college degree or higher. Means (SD) for the MDDI total score were 27.4 (7.7) for cisgender gay men, 26.4 (6.4) for cisgender bisexual plus men, 24.3 (6.1) for cisgender lesbian women, and 24.6 (5.5) for cisgender bisexual plus women. There were no significant differences in MDDI scores between cisgender gay and bisexual plus men, or between cisgender lesbian women and bisexual plus women in unadjusted or adjusted models.These normative data provide insights into the experience of MD symptoms among cisgender sexual minority men and women and can aid researchers and clinicians in the evaluation of MD symptoms and interpretation of MDDI scores in sexual minority populations.

    View details for DOI 10.1186/s12888-021-03302-2

    View details for PubMedID 34103034

  • Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine Flentje, A., Clark, K. D., Cicero, E., Capriotti, M. R., Lubensky, M. E., Sauceda, J., Neilands, T. B., Lunn, M. R., Obedin-Maliver, J. 2021

    Abstract

    Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma.To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people.Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes.Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health.Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health.

    View details for DOI 10.1093/abm/kaab051

    View details for PubMedID 34228052

  • Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among gender minority populations. Journal of eating disorders Nagata, J. M., Compte, E. J., McGuire, F. H., Lavender, J. M., Brown, T. A., Murray, S. B., Flentje, A., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J., Lunn, M. R. 2021; 9 (1): 87

    Abstract

    Representing the pathological extreme pursuit of muscularity, muscle dysmorphia (MD) is characterized by a pervasive belief or fear around insufficient muscularity and an elevated drive for muscularity. Despite evidence of heightened body image-related concerns among gender minority populations, little is known about the degree of MD symptoms among gender minorities, particularly based on Muscle Dysmorphic Disorder Inventory (MDDI) scores. The objective of this study was to assess community norms of the MDDI in gender-expansive people, transgender men, and transgender women.Data from participants in The PRIDE Study, an existing study of health outcomes in sexual and gender minority people, were examined. We calculated means, standard deviations, and percentiles for the MDDI total and subscale scores among gender-expansive people (i.e., those who identify outside of the binary system of man or woman; n = 1023), transgender men (n = 326), and transgender women (n = 177). The Kruskal-Wallis test was used to assess group differences and post hoc Dunn's tests were used to examine pairwise differences.Transgender men reported the highest mean MDDI total score (30.5 ± 7.5), followed by gender-expansive people (27.2 ± 6.7), then transgender women (24.6 ± 5.7). The differences in total MDDI score were driven largely by the Drive for Size subscale and, to a lesser extent, the Functional Impairment subscale. There were no significant differences in the Appearance Intolerance subscale among the three groups.Transgender men reported higher Drive for Size, Functional Impairment, and Total MDDI scores compared to gender-expansive people and transgender women. These norms provide insights into the experience of MD symptoms among gender minorities and can aid researchers and clinicians in the interpretation of MDDI scores among gender minority populations.

    View details for DOI 10.1186/s40337-021-00442-4

    View details for PubMedID 34261536