Sexual Identity and Behavior as Predictors of Pap Smear Utilization Among Sexually Active Women

Previous research has found that lesbians are less likely to report Pap smear utilization. However, this research is limited by both sampling techniques and measurement of sexual identity and behavior. No study of Pap smear utilization among sexually active women has used a large population-based sample and measured sexual identity (lesbian and bisexual) and gender(s) of sexual partners as separate independent variables.

Data were pooled from annual, random-digit-dial surveys of adult New Yorkers (2004-2006); the sample included 198 women who had sex with women (WSW) only and 170 women who had sex with women and men (WSWM) of 9,103 surveyed sexually active women.

Among all sexually active women, WSW only were less likely than WSWM (72.6% vs. 87.8%), who were less likely than women who had sex with men (87.8% vs. 92.4%) to report having had a Pap smear (p<.001 for all). In a multivariate logistic regression among all WSW, WSWM were less likely to report never having Pap smears (Adjusted Odds Ratio (AOR) = 0.06, 95% CI: 0.01-0.21) than WSW only. Compared with lesbian-identified women, heterosexual-identified (AOR = 11.25, 95% CI: 3.38-37.4) and bisexual-identified (AOR = 6.96, 95% CI: 1.43-33.82) women were more likely to report never having Pap smears.

Clinicians and researchers should be aware that WSW are a heterogeneous population, and variation in sexual behavior and identity affects their Pap smear utilization. Potential mechanisms that could be used to explain this variation will be discussed.