Social inequalities in cervical cancer screening among U.S. women by three dimensions of sexual orientation: Sexual attraction, sexual identity, and sex of sexual partners

Background: Lesbians and women who have sex with women (WSW) are less likely to have received a recent Pap test than heterosexual women and women who have sex only with men. Most prior studies on sexual orientation and Pap test use have relied on sub-national samples primarily consisting of highly-educated, middle-class, white women. Methods: We used the 2006-2010 National Survey of Family Growth to test whether a relationship exists between sexual attraction, sexual identity, and sex of sexual partners and Pap test use in the last year; test whether any of the observed associations differ by race/ethnicity, education, or poverty level; and identify the variables that may account for the observed associations. We generated prevalence estimates of Pap test use by each measure of sexual orientation and used multivariable logistic regression to account for covariates. Results: We found that, overall, women attracted to women were less likely to have received a Pap test than women only attracted to men. We also found that lesbians were less likely to have received a Pap test than heterosexual women, as were women with only female and no sexual partners compared to women with only male sexual partners. The associations between sexual attraction and sex of sexual partners and Pap test use differed by race/ethnicity, education, and poverty-level income. Conclusions: Inequalities in Pap test use exist by sexual attraction, sexual identity, and sex of sexual partners. Prevention efforts should consider how these inequalities might differ among women of different racial/ethnic and socioeconomic backgrounds.