- Dr. Brian Nguyen is an OB/GYN and family planning specialist at USC who combines information technology and community engagement to promote reproductive justice and responsibility.edit
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BACKGROUND The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions. OBJECTIVE This systematic review... more
BACKGROUND The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions. OBJECTIVE This systematic review examines: (i) female patients' gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students' education and career decisions. SEARCH STRATEGY We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research. SELECTION CRITERIA We restricted the review to original research from the United States between 2000-2021. DATA COLLECTION Fifteen studies met inclusion criteria, categorised into three groups: (i) patient's gender preference for Ob/Gyns; (ii) patient's gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions. MAIN RESULTS Patients prioritised their physician's care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post-clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity. CONCLUSIONS Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.
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OBJECTIVE To examine discrepancies in men's abortion reporting when queried via face-to-face interview versus audio computer-assisted self-interviewing (ACASI) in the National Survey of Family Growth (NSFG). STUDY DESIGN The NSFG... more
OBJECTIVE To examine discrepancies in men's abortion reporting when queried via face-to-face interview versus audio computer-assisted self-interviewing (ACASI) in the National Survey of Family Growth (NSFG). STUDY DESIGN The NSFG collects nationally representative data on family life, sexual behavior, and reproductive health in the United States. The questionnaire is administered to participants via face-to-face interview (FTF), with selected items also asked of the same participant via ACASI for direct comparison. As the 2015-2017 NSFG queried individuals' abortion history via both methods, we examined discrepant reporting among respondents. We additionally explored sociodemographic and reproductive characteristics associated with discrepant abortion reporting in a multivariable logistic regression model. RESULTS Of 4,540 male respondents ages 15-49, 45.3% reported a pregnancy. Via FTF, 12.3% reported an abortion, compared to 19.9% via ACASI (p<0.01). With respect to discrepancies in the number of reported abortions, 8.5% of respondents reported more abortions via ACASI versus FTF. Multivariable logistic regression modeling noted independently greater odds of abortion reporting in ACASI among non-Hispanic Black men (aOR 2.31, 95% CI 1.19-4.45), men living below the Federal Poverty Level (less than 100% FPL: aOR 3.65, 95% CI 1.93-6.89; 100-400% FPL: aOR 2.04, 95% CI 1.20-3.45), and those desiring more children in the future (aOR 1.91, 95% CI 1.20-3.04). CONCLUSION Men were more likely to disclose their abortions in ACASI compared to FTF interview. Disproportionate, discrepant abortion reporting among low-income, minority men who report desiring more children in the future warrants further research. IMPLICATIONS Surveys utilizing ACASI as an adjunct to FTF interviews may more accurately capture men's abortion experience.
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Vasectomy is a safe, effective, and cost-effective contraceptive method, with a failure rate lower than that of female sterilization. Nevertheless, vasectomy is underutilized—only 6% of American women rely on vasectomy. Access to... more
Vasectomy is a safe, effective, and cost-effective contraceptive method, with a failure rate lower than that of female sterilization. Nevertheless, vasectomy is underutilized—only 6% of American women rely on vasectomy. Access to vasectomy may be limited by provider advocacy and availability. Obstetricians and gynecologists can increase both the acceptability of and access to this method if adequately trained to counsel about and provide the procedure. Although some concerns may persist surrounding obstetricians and gynecologists performing a vasectomy, increasing the availability and uptake of vasectomy avoids unnecessary surgical risks for female patients and promotes reproductive justice via shared contraceptive responsibility.
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Although women are the focal point of abortion care, a woman’s male partner may accompany her to the abortion appointment. Using Connell’s “hierarchy of masculinities” framework, this study examines how male partners negotiate their... more
Although women are the focal point of abortion care, a woman’s male partner may accompany her to the abortion appointment. Using Connell’s “hierarchy of masculinities” framework, this study examines how male partners negotiate their identity and role in an unfamiliar setting while their female partners undergo an abortion. Twenty-seven in-depth interviews with male partners of women obtaining abortions at a community-based and a university-based abortion clinic were conducted. The interviews reflected the tension male partners felt while attempting to maintain characteristics of hegemonic masculinity (e.g., dominance, stoicism, ambition, and fatherhood) in an environment where their female partner’s needs were prioritized. Some male partners expressed distress about their inexperience with the process and procedure as well as their inability to participate or better care for their partners. Others negotiated alternative definitions of masculinity, emphasizing a duty and/or desire to...
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INTRODUCTION:Clinical trials of novel male hormonal contraceptives (MHCs) promise effective methods that may decrease global unmet needs for contraception. However, concerns about potential harms may influence uptake and impede... more
INTRODUCTION:Clinical trials of novel male hormonal contraceptives (MHCs) promise effective methods that may decrease global unmet needs for contraception. However, concerns about potential harms may influence uptake and impede development. No review has systematically documented the range and frequ
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Although men are commonly viewed as unaware, uninvolved and even obstructive regarding their partner's abortion access, those who accompany women to an abortion appointment may be more supportive. A better understanding of men's... more
Although men are commonly viewed as unaware, uninvolved and even obstructive regarding their partner's abortion access, those who accompany women to an abortion appointment may be more supportive. A better understanding of men's motivations could inform clinic policies regarding their involvement. In 2015-2016, data were collected from male partners of women seeking an abortion at two clinics in a large Midwestern city. Twenty-nine interviews were conducted to explore how men wanted to be involved in the abortion and why they accompanied their partners. Thematic content analysis was used to examine these data, and emergent themes informed a survey, completed by 210 men, that focused on perceptions about and reasons for accompaniment. Descriptive statistics were calculated for the survey data. Four in 10 interviewees were aged 25-34, as were half of survey respondents. Overall, most had at least some college education and were in long-term or committed relationships. Intervie...
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Research Interests: Demography, Adolescent, Medicine, Humans, Female, and 15 moreMale, Data Collection, Purchasing, Rhode Island, Middle Aged, Questionnaires, Adult, Public health systems and services research, Emergency Contraception, Odds ratio, Cross Sectional Studies, Pharmacies, Confidence Interval, Health Services Accessibility, and Paediatrics and reproductive medicine
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Research Interests: Family Medicine, Medicine, Humans, Female, Male, and 5 morePhysicians, Men, Vasectomy, Family Planning, and Health Care Surveys
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OBJECTIVE Reddit is one of the most popular websites in the United States because of its user-driven aggregation and community-based curation of online content. We describe the use and impact of Reddit's Ask Me Anything platform, for... more
OBJECTIVE Reddit is one of the most popular websites in the United States because of its user-driven aggregation and community-based curation of online content. We describe the use and impact of Reddit's Ask Me Anything platform, for public engagement and education about developments in hormonal male contraception (HMC). METHODS We analyzed the content from and user engagement with two Reddit Ask Me Anything events that answered user queries about HMC in June 2018 and March 2019. Clinical trial investigators provided real-time responses throughout the events. We examined the 25 most popular posts from each event, analyzing content for salient themes via an inductive approach. To quantify event impact, we examined Google Trends data and subsequent traffic to the investigator website. RESULTS Over 18,000 registered Reddit users interacted with each of the two Ask Me Anything events, with each generating over 1,600 comments. The most popular posts of each Ask Me Anything event expressed interest in off-target effects associated with the use of HMCs. Additional themes included queries about previous and ongoing clinical trials, HMC physiology, and market analyses and projections of public willingness to use HMCs. The events coincided with a spike in both Google searches for "male birth control" and first-time visits to the study's website where users could express interest in participating in clinical trials. CONCLUSION Reddit Ask Me Anything events conducted by HMC investigators revealed wide public interest in HMCs. The events prompted further searches for more information on male contraception, while driving traffic to the investigator website for trial recruitment purposes. IMPLICATIONS Reddit Ask Me Anything events are a popular, cost-free online platform for publicly responding to a range of HMC-related queries, while providing investigators with insight into stakeholder priorities and preoccupations.
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Purpose: To identify patient factors associated with medical management failure and hospital readmission among patients admitted with a diagnosis of tuboovarian abscess at a public hospital in Los Angeles, California. Methods: We... more
Purpose: To identify patient factors associated with medical management failure and hospital readmission among patients admitted with a diagnosis of tuboovarian abscess at a public hospital in Los Angeles, California. Methods: We conducted a retrospective chart review of admissions for tuboovarian abscess from January 2014 through August 2019, describing treatment plans and their subsequent outcomes. Patient factors associated with failure of medical management, as defined by requiring image-guided drainage or surgery, and hospital readmission were identified via bivariate analyses, using Chi-square, Fisher’s exact, and Wilcoxon signed-rank tests as appropriate. Factors independently linked to failure of medical management were determined via logistic regression. Results: We treated 147 patients with tuboovarian abscess over 5 years, comprised primarily of Hispanic/Latinx (74%; n=109/147) women, median age 39 (range: 18-70) years. The median abscess size was 6.3cm (range: 4.8-8.0). ...
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METHODS: In-depth qualitative interviews were conducted with currently-practicing anesthesia providers, who care for obstetric (OB) patients. A semi-structured interview guide elicited information on providers’ personal abortion attitudes... more
METHODS: In-depth qualitative interviews were conducted with currently-practicing anesthesia providers, who care for obstetric (OB) patients. A semi-structured interview guide elicited information on providers’ personal abortion attitudes through case-based examples and a discussion of Georgia’s (GA) 22-week abortion ban. Data were analyzed in an iterative fashion using both inductive and deductive approaches.
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OBJECTIVES Limited research and guidance on the use of "withdrawal" or coitus interruptus for contraception lead to inconsistent or even inaccurate physician recommendations regarding its use. Consequently, patients rely on... more
OBJECTIVES Limited research and guidance on the use of "withdrawal" or coitus interruptus for contraception lead to inconsistent or even inaccurate physician recommendations regarding its use. Consequently, patients rely on online communities to learn about this commonly used contraceptive method. To identify knowledge gaps and concerns between men and women, as well as explore how they use withdrawal, we examined withdrawal-related posts on the popular internet discussion forum, Reddit. STUDY DESIGN To explore gendered variations in withdrawal-related Reddit posts, we extracted posts from the gendered forums: "TwoXChromosomes," "Askwomen," "Askmen," and "OneY" between 2010-2019 that contained the search terms: "coitus interruptus," "withdrawal," "pull out," "pre-ejaculate," or "pre-cum." We developed an initial codebook with expected codes and augmented it with emerging findings from a random sampling of 10% of posts. We revised iteratively for inter-rater agreement, after which researchers coded the remaining posts independently. RESULTS Of 269 withdrawal-related queries, 19% were submitted by men; 81% referenced the contributor's own withdrawal use. Salient domains included: concerns about pregnancy risk (59%), how to effectively use withdrawal (13%), benefits/pleasure from using withdrawal (12%), impact on personal life/relationship (9%), and problems encountered, inclusive of consent (7%). Posts to female-focused forums more frequently inquired about pregnancy risk, while those on male forums more frequently inquired about withdrawal-related logistics (p<0.001); domains were not associated with contributor gender. CONCLUSION Withdrawal-related queries within this Reddit sample are frequently posted by women, the majority of whom want to understand their risk of pregnancy with withdrawal. Research operationalizing withdrawal and more accurately estimating withdrawal-related pregnancy risk is warranted. IMPLICATIONS Reddit users discuss their personal experiences with withdrawal as contraception, as well as seek advice regarding its use from the online community. Pregnancy risk, logistics of use and ongoing stigma are salient topics. Further research on pregnancy risk, operationalizing success, and approaches for discussing this behavioral method is warranted.
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OBJECTIVE Reddit is one of the most popular websites in the United States because of its user-driven aggregation and community-based curation of online content. We describe the use and impact of Reddit's Ask Me Anything platform, for... more
OBJECTIVE Reddit is one of the most popular websites in the United States because of its user-driven aggregation and community-based curation of online content. We describe the use and impact of Reddit's Ask Me Anything platform, for public engagement and education about developments in hormonal male contraception (HMC). METHODS We analyzed the content from and user engagement with two Reddit Ask Me Anything events that answered user queries about HMC in June 2018 and March 2019. Clinical trial investigators provided real-time responses throughout the events. We examined the 25 most popular posts from each event, analyzing content for salient themes via an inductive approach. To quantify event impact, we examined Google Trends data and subsequent traffic to the investigator website. RESULTS Over 18,000 registered Reddit users interacted with each of the two Ask Me Anything events, with each generating over 1,600 comments. The most popular posts of each Ask Me Anything event expr...
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Background As war and famine are population level stressors that have been historically linked to menstrual cycle abnormalities, we hypothesized that the COVID-19 pandemic could similarly affect ovulation and menstruation among women.... more
Background As war and famine are population level stressors that have been historically linked to menstrual cycle abnormalities, we hypothesized that the COVID-19 pandemic could similarly affect ovulation and menstruation among women. Methodology We conducted a retrospective cohort study examining changes in ovulation and menstruation among women using the Natural Cycles mobile tracking app. We compared de-identified cycle data from March-September 2019 (pre-pandemic) versus March-September 2020 (during pandemic) to determine differences in the proportion of users experiencing anovulation, abnormal cycle length, and prolonged menses, as well as population level changes in these parameters, while controlling for user-reported stress during the pandemic. Findings We analyzed data from 214,426 cycles from 18,076 app users, primarily from Great Britain (29.3%) and the United States (22.6%). The average user was 33 years of age; most held at least a university degree (79.9%). Nearly half...
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BACKGROUND Racial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans' adoption... more
BACKGROUND Racial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans' adoption of new medical technologies, inclusive of contraception. Efforts to develop hormonal male contraceptives need to incorporate Black Americans' experiences and perspectives so that new contraceptives enable their reproductive goals and promote gender equity. METHODS Working with our community-based partner, Healthy African American Families in Los Angeles, California, we conducted six 60-minute focus group discussions with 39 Black men over age 18, in ongoing heterosexual relationships, to explore attitudes towards and willingness to use hormonal male contraceptives. RESULTS Just over one-third (35%) of respondents reported willingness to use or rely on hormonal male contraceptives. The majority held negative attitudes about hormonal male contraceptives, citing concerns about side effects and safety. Several respondents expressed mistrust of the medical community and medical research, noting that hormonal male contraceptives could be used against Black communities; several expressed unwillingness to trial hormonal male contraceptives without years of testing. However, all groups described scenarios where they would use them despite stated concerns. CONCLUSIONS Black men's hypothetical willingness to use hormonal male contraceptives is limited by medical mistrust, which may be overcome by their concerns about the unreliability of current options or the contraceptive behaviors of female partners. Nevertheless, addressing Black Americans' history of medical mistreatment and exploitation will be essential for hormonal male contraceptives to positively contribute to Black men's reproductive options and agency.
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PURPOSE Using U.S. National Survey of Family Growth (NSFG) data from 2006 to 2013, we characterized men aged 15-44 years who reported not using a condom at their first vaginal intercourse (coitarche), while in a non-steady relationship... more
PURPOSE Using U.S. National Survey of Family Growth (NSFG) data from 2006 to 2013, we characterized men aged 15-44 years who reported not using a condom at their first vaginal intercourse (coitarche), while in a non-steady relationship with a female partner. METHODS Men who reported ever having intercourse were asked about male and female contraceptives used at coitarche. Analysis was restricted to respondents whose first sexual relationship was reported as non-steady, thereby comprising a population for whom condoms are recommended for preventing both pregnancy and sexually transmitted infections. Demographic and behavioral factors were examined against condom use, with significant associations included in multivariable logistic regression. We additionally describe young men's receipt of various components of sex education prior to coitarche. RESULTS Nearly half (43%) of men aged 15-44 in the U.S. reported not using a condom at coitarche during a non-steady relationship. Among these men, coitarche was reported on average at 16 years old; more than one third (37%) endorsed mixed feelings or not wanting to have sex at the time. Older men (adjusted odds ratio [adjOR] 1.07, 95% confidence interval [CI] 1.06-1.08), as with men from earlier National Survey of Family Growth cycles, were increasingly likely to have reported unprotected coitarche. Similarly, men reporting coitarche before the age of 15 (adjOR 2.39, 95% CI 1.99-2.87) or having a younger sex partner at coitarche (adjOR 1.73, 95% CI 1.11-2.69) were more likely to have not used condoms. About three quarters of men received at least some form of sex education prior to coitarche. CONCLUSIONS Condomless coitarche is commonly reported among men in non-steady adolescent relationships and with mixed feelings about having sex. Condomless coitarche among these men is independently associated with initiating sex before the age of 15 and having sex with a younger female partner. These findings may guide how to structure young men's sexual education programing.
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BACKGROUND Maternal and paternal age at first birth is increasing across the global population. Spontaneous abortion, one of the most common abnormal pregnancy outcomes, is known to occur more frequently with increasing maternal age.... more
BACKGROUND Maternal and paternal age at first birth is increasing across the global population. Spontaneous abortion, one of the most common abnormal pregnancy outcomes, is known to occur more frequently with increasing maternal age. However, the relationship of advanced paternal age and spontaneous abortion is poorly understood and previous results have yielded conflicting results. OBJECTIVE To examine the influence of paternal age on the risk of spontaneous abortion (SAB) among singleton pregnancies conceived without assisted reproductive technologies. STUDY DESIGN Retrospective, case-control study using combined pregnancy data from the CDC's 2011-2013 and 2013-2015 National Survey of Family Growth. Spontaneous, singleton pregnancy data from women, ages 15-45 years, were analyzed. Ongoing pregnancies, induced abortions, ectopic pregnancies, preterm births, and intrauterine fetal deaths were excluded. Bivariate associations of pregnancy outcome (SAB at <20 weeks and <12 weeks versus live birth at >37 weeks) and paternal age were determined, along with those of maternal age and select demographic and pregnancy characteristics. Significant associations were included in a multivariable logistic regression, which accounted for multiple pregnancies derived from the same respondent. RESULTS A total of 12,710 pregnancies from 6,979 women were analyzed, consisting of 2,300 (18.2%) SABs and 10,410 (81.8%) term live births. Median maternal and paternal ages were 25 and 28, respectively. After adjusting for maternal age, race/ethnicity, socioeconomic status, marital status, and pregnancy intention, pregnancies resulting in SAB had 2.05 (95%CI 1.06-2.20) times the odds of being from a father aged 50 years or older, versus 25-29 years of age. These relationships remained significant when defining SABs at < 12 weeks (adjOR: 2.30, 95%CI 1.17-4.52). CONCLUSIONS Paternal age may increase the odds of SAB, independent of select factors, including demographics, pregnancy intention, and maternal age. This association was robust across several gestational age-based definitions of SAB, even after adjustment.
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Outbreaks of mosquito-borne viral illnesses commonly occur after storms. As storms are predicted to worsen in intensity and frequency, mosquito-borne viruses, including the Zika virus are expected to spread, and with devastating... more
Outbreaks of mosquito-borne viral illnesses commonly occur after storms. As storms are predicted to worsen in intensity and frequency, mosquito-borne viruses, including the Zika virus are expected to spread, and with devastating consequences. While the disease is self-limited, pregnant women who contract Zika can transmit the virus to their fetuses, causing neurodevelopmental abnormalities, including microcephaly. An overlooked vector of the Zika virus, however, is men whose semen can transmit the virus at the time of sexual intercourse. Current recommendations for preventing the sexual transmission of Zika are inadequate and need to emphasize male reproductive responsibility, via expanding services for men's family planning and developing novel male contraceptives. To prevent the sexual transmission of Zika, the World Health Organization recommends that couples use condoms or abstain from sexual activity for at least 6 months when traveling in Zika-infected areas. Strict adhere...
To assess current practices regarding female and male sterilization counseling and provision, as well as determine interest in providing vasectomy among family planning specialists. Members of the US-based network of family planning... more
To assess current practices regarding female and male sterilization counseling and provision, as well as determine interest in providing vasectomy among family planning specialists. Members of the US-based network of family planning fellowship physicians (current fellows, graduates and faculty) received a Web-based survey from November 2015 through January 2016 regarding current sterilization preferences and practices, as well as interest in obtaining training in vasectomy counseling and procedure. Nearly 60% (n=178/302) of family planning fellowship providers responded to the survey. While 62% (111/178) of respondents reported counseling their patients about vasectomy at least most of the time and 57% (102/178) recommended vasectomy over female sterilization, few (8/178; 4 trained in family medicine and 4 trained in obstetrics and gynecology) had performed a vasectomy in the last year. Nearly 90% (158/178) of respondents were somewhat or very interested in receiving training on vas...
Research Interests: Obstetrics, Contraception, Family Practice, Medicine, Counseling, and 13 moreHumans, United States, Female, Male, Physicians, Vasectomy, Clinical Sciences, Gynecology, Public health systems and services research, Elsevier, Health Personnel, Surveys and Questionnaires, and Paediatrics and reproductive medicine
Although some women may desire the involvement of their partners when obtaining abortion care, male partners are not routinely included in the abortion process. A review of the literature on how male involvement relates to... more
Although some women may desire the involvement of their partners when obtaining abortion care, male partners are not routinely included in the abortion process. A review of the literature on how male involvement relates to women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s abortion experiences may help guide facilities that are considering incorporating male partners in abortion care. PubMed, PsycINFO (Ovid), the Cumulative Index to Nursing and Allied Health Literature, the Latin American and Caribbean Health Sciences Literature database, and the Cochrane Library were systematically searched without restrictions through September 23, 2015, to identify qualitative and quantitative primary studies investigating male partner accompaniment during the abortion process in noncoercive situations. Analysis focused on identifying different types of male involvement and their associations with women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s abortion experiences. Some 1,316 unique articles were reviewed; 15 were analyzed. These studies were conducted in six countries and published between 1985 and 2012, primarily with observational designs. Four types of male partner involvement emerged: presence in the medical facility, participation in preabortion counseling, presence in the room during the surgical abortion procedure or while the woman is experiencing the effects of abortifacient medications, and participation in postabortion care. Studies explored relationships between type of involvement and women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s access to abortion care and their emotional and physical well-being. Most findings suggested that male involvement was positively associated with women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s well-being and their assessment of the experience; no negative associations were found. In noncoercive circumstances, women who include their male partners in the abortion process may find this involvement beneficial.