Juno Obedin-Maliver, MD, MPH, MAS, FACOG, is an Assistant Professor in the Department of Obstetrics and Gynecology at Stanford University School of Medicine.
Dr. Juno Obedin-Maliver is a board-certified obstetrician/gynecologist who provides excellent clinical care and strives to advance scientific knowledge through her research.
She practices full-spectrum gynecology including outpatient, in-patient, operative, and emergency care services. This specifically includes collaborative management of cervical dysplasia and abnormal pap smears, abnormal uterine bleeding, contraception and family planning, pelvic pain, abnormal discharge, sexually transmitted infection testing and treatment, and more. She specializes in the gynecological and reproductive health care needs of sexual and gender minority people which include but are not limited to lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) people. This interest and experience drives her research interests towards promoting the health and well-being and equity of LGBTQ people.
Dr. Obedin-Maliver, is the Co-Director of The PRIDE Study (pridestudy.org), a multi-site online prospective longitudinal cohort of sexual and gender minority individuals based at Stanford. She also serves on the medical advisory board of the University of California San Francisco Center of Excellence for Transgender Health and is helping to author the next version of the World Professional Association for Transgender Health (WPATH) Standards of Care. Dr. Obedin-Maliver has also been active in health policy including involvement in helping to legally redefine consideration of sexually intimate partner status and to remove the Medicare Non-Coverage Determination ruling on gender -affirming surgeries.
- Obstetrics and Gynecology
- LGBTQ+ Health
- Reproductive Health of Transgender People
- Family Planning
Assistant Professor - Med Center Line, Obstetrics & Gynecology - General
Honors & Awards
1st Place Expert Choice: Improving Wait Times and Care Integration for Transgender Patients, San Francisco Veterans Affairs (SFVA) Systems Improvement Fair (2018)
GET(Gene, Environments, Traits)y Diversity Award, GET Award Committee (2016)
Outstanding Resident Award, University of California, San Francisco - Nurse-Midwifery Student Award for Resident Physicians (2014)
Chancellor’s Award for Gay, Lesbian Bisexual and/or Transgender (GLBT) Leadership, University of California, San Francisco (2012)
Outstanding Resident Award in Medical Student Teaching - Obstetrics and Gynecology., University of California, San Francisco (2011)
Julius R. Krevans Award for Service as an Intern, San Francisco General Hospital (2011)
eQuality Scholarship for service to the LGBTQ community, The Kaiser Permanente Foundation (2010)
Scholarship for Lesbian, Gay, Bisexual, and Transgender (LGBT) Activism and Leadership, Markowski-Leach Memorial Fund (2008)
Cardinal Free Clinic - Student Member Service Award, Stanford University School of Medicine (2008)
Full Tuition Merit Scholarship, School of Public Health - Master's Program, University of California at Berkeley (2007)
Ingenuity Award for Community Service, Hampshire College (2004)
Reproductive Rights Activist Service Corps Internship Grant, Civil Liberties and Public Policy Program (2002)
Scholarship for Achievement in the Sciences, Canon-Jensen Memorial Fund (2001)
Scholarship for Academic Achievement in the Sciences, Monterey Bay Women In Science Fund (2001)
Fellowship, San Francisco Veterans Affairs Medical Center & University of California, San Francisco, Women's Health and Clinical Research (2016)
MAS, University of California, San Francisco, Clinical Research (2016)
Board Certification: Obstetrics and Gynecology, American Board of Obstetrics and Gynecology (2015)
Residency:UCSF Obstetrics and Gynecology Residency (2014) CA
Medical Education:Stanford University School of Medicine Registrar (2010) CA
MPH, University of California, Berkeley, Masters in Public Health (2008)
More Similarities Than Differences? An Exploratory Analysis Comparing the Sexual Complaints, Sexual Experiences, and Genitourinary Health of Older Sexual Minority and Sexual Majority Adults.
The Journal of Sexual Medicine
2019; 16 (3): 347-350
View details for DOI 10.1016/j.jsxm.2019.01.308
- Opening the Ob/Gyn Door to Sexual and Gender Minority Patients Contemporary Ob/Gyn. Volume 64, No 01. 2019 11–15
Urinary Incontinence in a National Cohort of Older Women: Implications for Caregiving and Care Dependence
JOURNAL OF WOMENS HEALTH
2018; 27 (9): 1097–1103
Urinary incontinence (UI) can interfere with older women's ability to perform activities of daily living (ADLs), but little is known about factors that predispose incontinent women to become functionally dependent or compromise their ability to serve as caregivers to others.UI, caregiving, and care-receiving behaviors were assessed by questionnaire in a national sample of community-dwelling older women. Multivariable models evaluated associations between incontinence and care dependence, assessed factors associated with care dependence among incontinent women, and compared health among female caregivers with and without incontinence.Of the 1703 women, 27% reported weekly or more incontinence and 13% monthly incontinence. Women with weekly or more incontinence were more likely than women without incontinence to report receiving care for ADLs (AOR = 2.39, CI = 1.61-3.56) or instrumental ADLs (AOR = 1.94, CI = 1.42-2.63). Compared to 46% of women without incontinence, 60% of women with monthly or weekly incontinence reported unmet care needs (p = 0.0002). Factors associated with care dependence included more frequent incontinence, older age, marital status, and fair/poor health (p < 0.05 for all). Overall, 15% of women served as a caregiver for another adult, which did not differ by incontinence status (p = 0.84), but female caregivers with incontinence reported worse health than those without incontinence (p = 0.0004).In this national cohort, older women with incontinence were more likely to be functionally dependent and have unmet care needs than those without incontinence, after adjustment for other factors. At least one in ten incontinent women served as caregivers, despite having worse health than female caregivers without incontinence.
View details for DOI 10.1089/jwh.2017.6891
View details for Web of Science ID 000435559200001
View details for PubMedID 29902123
View details for PubMedCentralID PMC6148721
The new era of precision population health: insights for the All of Us Research Program and beyond.
Journal of translational medicine
2018; 16 (1): 211
Although precision medicine has made advances in individualized patient treatments, there needs to be continued attention on tailored population health and prevention strategies (often termed "precision population health"). As we continue to link datasets and use "big data" approaches in medicine, inclusion of diverse populations and a focus on disparities reduction are key components within a precision population health framework. Specific recommendations from the All of Us Research Program and the Precision Public Health Summit provide examples for moving this field forward.
View details for DOI 10.1186/s12967-018-1585-5
View details for PubMedID 30053823
View details for PubMedCentralID PMC6062956
From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers
BMC PREGNANCY AND CHILDBIRTH
2017; 17: 332
Some transgender men retain their uterus, get pregnant, and give birth. However, societal attitudes about gender have erected barriers to openly being pregnant and giving birth as a transgender man. Little research exists regarding transgender men's reproductive needs. Anecdotal observations suggest that social change and increasing empowerment of transgender men may result in increasing frequency and openness about pregnancy and birth. Specific needs around conception, pregnancy, and newborn care may arise from transphobia, exogenous testosterone exposure, or from having had (or desiring) gender-affirming surgery. We undertook a qualitative study to understand the needs of transgender men who had given birth.We interviewed 10 transgender men who had been recruited for a recently published online cross-sectional survey of individuals (n = 41). Subjects had given birth while identifying as male. Interviews were recorded, transcribed, and systematically coded. Analysis used a priori and emergent codes to identify central themes and develop a framework for understanding participant experiences.Participants reported diverse experiences and values on issues including prioritization and sequencing of transition versus reproduction, empowerment in healthcare, desire for external affirmation of their gender and/or pregnancy, access to social supports, and degree of outness as male, transgender, or pregnant. We identified structural barriers that disempowered participants and describe healthcare components that felt safe and empowering. We describe how patients' strategies, and providers' behaviors, affected empowerment. Anticipatory guidance from providers was central in promoting security and empowerment for these individuals as patients.Recognizing diverse experiences has implications in supporting future patients through promoting patient-centered care and increasing the experiential legibility. Institutional erasure creates barriers to transgender men getting routine perinatal care. Identifying this erasure helps shape recommendations for how providers and clinics can provide appropriate care. Specific information regarding reproduction can be helpful to patients. We provide recommendations for providers' anticipatory guidance during the pre-transition, pre-conception, prenatal, and postpartum periods. Ways to support and bring visibility to the experience of transgender men are identified. Improving clinical visibility and affirming gender will likely enhance patient experience and may support patient-centered perinatal healthcare services.
View details for DOI 10.1186/s12884-017-1491-5
View details for Web of Science ID 000415331900002
View details for PubMedID 29143629
View details for PubMedCentralID PMC5688401
- Gynecologic Care for Transgender Adults CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017; 6 (2): 140–48
Contraceptive use and pregnancy intentions among transgender men presenting to a clinic for sex workers and their families in San Francisco
2017; 95 (2): 186–89
Although many transgender men may be able to conceive, their reproductive health needs are understudied.We retrospectively reviewed charts of transgender men presenting to a clinic for sex workers to describe the proportion at risk for pregnancy, pregnancy intentions, and contraceptive use.Of 26 transgender men identified, half were at risk for pregnancy. Most desired to avoid pregnancy but used only condoms or no contraception. Two individuals desired pregnancy, were taking testosterone (a teratogen), and not using contraception.Further research is needed to explore how to best provide family planning services including preconception and contraception care to transgender men.
View details for DOI 10.1016/j.contraception.2016.09.005
View details for Web of Science ID 000392895300011
View details for PubMedID 27621044
Feasibility of Vaginal Hysterectomy for Female-to-Male Transgender Men.
Obstetrics and gynecology
2017; 129 (3): 457–63
To describe the hysterectomy data among a cohort of transgender men and nontransgender (ie, cisgender) women with a particular goal to evaluate the feasibility of vaginal hysterectomy among transgender men.This cohort study includes all hysterectomies performed for benign indications on transgender men and cisgender women at a single academic county hospital from 2000 to 2012. Hysterectomy cases and patient gender were identified by billing records and confirmed by review of medical records. Primary study outcome was the hysterectomy route among transgender men compared with cisgender women. We also examined risk factors and operative outcomes. Student two-sided t tests, χ analysis, and descriptive statistics are presented; sensitivity analyses using regression techniques were performed.Hysterectomies for benign gynecologic procedures were performed in 883 people: 33 on transgender men and 850 on cisgender women. Transgender men were younger, had fewer pregnancies and deliveries, and smaller uteri. The leading indication for hysterectomy differed significantly: pain (85%) was most common among transgender men (compared with 22% in cisgender women; P<.001), whereas leiomyomas (64%) was most common for cisgender women (compared with 21% in transgender men; P<.001). Vaginal hysterectomies were performed in 24% transgender men and 42% of cisgender women. Estimated blood loss was less among transgender men (P=.002), but when uterine size and route of hysterectomy were considered, the difference between gender groups was no longer significant. There was no difference in patients experiencing complications between the groups.Transgender men and cisgender women have different preoperative characteristics and surgical indications. Vaginal hysterectomies have been successfully completed among transgender men. Because vaginal hysterectomy is a viable procedure for this population, it should be considered in surgical planning for transgender men.
View details for PubMedID 28178042
- Transgender men and pregnancy OBSTETRIC MEDICINE 2016; 9 (1): 4–8
Lesbian, Gay, Bisexual, and Transgender Patient Care: Medical Students' Preparedness and Comfort.
Teaching and learning in medicine
2015; 27 (3): 254-263
Phenomenon: Lesbian, gay, bisexual, and transgender (LGBT) individuals face significant barriers in accessing appropriate and comprehensive medical care. Medical students' level of preparedness and comfort caring for LGBT patients is unknown.An online questionnaire (2009-2010) was distributed to students (n = 9,522) at 176 allopathic and osteopathic medical schools in Canada and the United States, followed by focus groups (2010) with students (n = 35) at five medical schools. The objective of this study was to characterize LGBT-related medical curricula, to determine medical students' assessments of their institutions' LGBT-related curricular content, and to evaluate their comfort and preparedness in caring for LGBT patients.Of 9,522 survey respondents, 4,262 from 170 schools were included in the final analysis. Most medical students (2,866/4,262; 67.3%) evaluated their LGBT-related curriculum as "fair" or worse. Students most often felt prepared addressing human immunodeficiency virus (HIV; 3,254/4,147; 78.5%) and non-HIV sexually transmitted infections (2,851/4,136; 68.9%). They felt least prepared discussing sex reassignment surgery (1,061/4,070; 26.1%) and gender transitioning (1,141/4,068; 28.0%). Medical education helped 62.6% (2,669/4,262) of students feel "more prepared" and 46.3% (1,972/4,262) of students feel "more comfortable" to care for LGBT patients. Four focus group sessions with 29 students were transcribed and analyzed. Qualitative analysis suggested students have significant concerns in addressing certain aspects of LGBT health, specifically with transgender patients. Insights: Medical students thought LGBT-specific curricula could be improved, consistent with the findings from a survey of deans of medical education. They felt comfortable, but not fully prepared, to care for LGBT patients. Increasing curricular coverage of LGBT-related topics is indicated with emphasis on exposing students to LGBT patients in clinical settings.
View details for DOI 10.1080/10401334.2015.1044656
View details for PubMedID 26158327
Sexual and Gender Minority Identity Disclosure During Undergraduate Medical Education: "In the Closet" in Medical School
2015; 90 (5): 634-644
To assess identity disclosure among sexual and gender minority (SGM) students pursuing undergraduate medical training in the United States and Canada.From 2009 to 2010, a survey was made available to all medical students enrolled in the 176 MD- and DO-granting medical schools in the United States and Canada. Respondents were asked about their sexual and gender identity, whether they were "out" (i.e., had publicly disclosed their identity), and, if they were not, their reasons for concealing their identity. The authors used a mixed-methods approach and analyzed quantitative and qualitative survey data.Of 5,812 completed responses (of 101,473 eligible respondents; response rate 5.7%), 920 (15.8%) students from 152 (of 176; 86.4%) institutions identified as SGMs. Of the 912 sexual minorities, 269 (29.5%) concealed their sexual identity in medical school. Factors associated with sexual identity concealment included sexual minority identity other than lesbian or gay, male gender, East Asian race, and medical school enrollment in the South or Central regions of North America. The most common reasons for concealing one's sexual identity were "nobody's business" (165/269; 61.3%), fear of discrimination in medical school (117/269; 43.5%), and social or cultural norms (110/269; 40.9%). Of the 35 gender minorities, 21 (60.0%) concealed their gender identity, citing fear of discrimination in medical school (9/21; 42.9%) and lack of support (9/21; 42.9%).SGM students continue to conceal their identity during undergraduate medical training. Medical institutions should adopt targeted policies and programs to better support these individuals.
View details for DOI 10.1097/ACM.0000000000000657
View details for Web of Science ID 000353879700027
View details for PubMedID 25692563
- Time for OBGYNs to Care for People of All Genders JOURNAL OF WOMENS HEALTH 2015; 24 (2): 109–11
Transgender men who experienced pregnancy after female-to-male gender transitioning.
Obstetrics and gynecology
2014; 124 (6): 1120–27
To conduct a cross-sectional study of transgender men who had been pregnant and delivered after transitioning from female-to-male gender to help guide practice and further investigation.We administered a web-based survey from March to December 2013 to inquire about demographics, hormone use, fertility, pregnancy experience, and birth outcomes. Participants were not required to have been on hormone therapy to be eligible. We used a mixed-methods approach to evaluate the quantitative and qualitative data.Forty-one self-described transgender men completed the survey. Before pregnancy, 61% (n=25) had used testosterone. Mean age at conception was 28 years with a standard deviation of 6.8 years. Eighty-eight percent of oocytes (n=36) came from participants' own ovaries. Half of the participants received prenatal care from a physician and 78% delivered in a hospital. Qualitative themes included low levels of health care provider awareness and knowledge about the unique needs of pregnant transgender men as well as a desire for resources to support transgender men through their pregnancy.Transgender men are achieving pregnancy after having socially, medically, or both transitioned. Themes from this study can be used to develop transgender-appropriate services and interventions that may improve the health and health care experiences of transgender men.
View details for DOI 10.1097/AOG.0000000000000540
View details for PubMedID 25415163
- Lesbian, Gay, Bisexual, and Transgender Health and Medical Education Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 2011; 306 (21): 2326–27
Lesbian, Gay, Bisexual, and Transgender-Related Content in Undergraduate Medical Education
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
2011; 306 (9): 971-977
Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health and health care disparities and have specific health care needs. Medical education organizations have called for LGBT-sensitive training, but how and to what extent schools educate students to deliver comprehensive LGBT patient care is unknown.To characterize LGBT-related medical curricula and associated curricular development practices and to determine deans' assessments of their institutions' LGBT-related curricular content.Deans of medical education (or equivalent) at 176 allopathic or osteopathic medical schools in Canada and the United States were surveyed to complete a 13-question, Web-based questionnaire between May 2009 and March 2010.Reported hours of LGBT-related curricular content.Of 176 schools, 150 (85.2%) responded, and 132 (75.0%) fully completed the questionnaire. The median reported time dedicated to teaching LGBT-related content in the entire curriculum was 5 hours (interquartile range [IQR], 3-8 hours). Of the 132 respondents, 9 (6.8%; 95% CI, 2.5%-11.1%) reported 0 hours taught during preclinical years and 44 (33.3%; 95% CI, 25.3%-41.4%) reported 0 hours during clinical years. Median US allopathic clinical hours were significantly different from US osteopathic clinical hours (2 hours [IQR, 0-4 hours] vs 0 hours [IQR, 0-2 hours]; P = .008). Although 128 of the schools (97.0%; 95% CI, 94.0%-99.9%) taught students to ask patients if they "have sex with men, women, or both" when obtaining a sexual history, the reported teaching frequency of 16 LGBT-specific topic areas in the required curriculum was lower: at least 8 topics at 83 schools (62.9%; 95% CI, 54.6%-71.1%) and all topics at 11 schools (8.3%; 95% CI, 3.6%-13.0%). The institutions' LGBT content was rated as "fair" at 58 schools (43.9%; 95% CI, 35.5%-52.4%). Suggested successful strategies to increase content included curricular material focusing on LGBT-related health and health disparities at 77 schools (58.3%, 95% CI, 49.9%-66.7%) and faculty willing and able to teach LGBT-related curricular content at 67 schools (50.8%, 95% CI, 42.2%-59.3%).The median reported time dedicated to LGBT-related topics in 2009-2010 was small across US and Canadian medical schools, but the quantity, content covered, and perceived quality of instruction varied substantially.
View details for Web of Science ID 000294542600015
View details for PubMedID 21900137