Reproductive Health Screening Disparities and Sexual Orientation in a Cohort Study of U.S. Adolescent and Young Adult Females

Abstract

Purpose To examine sexual orientation group disparities in Pap and STI/HPV tests among adolescents and young adult females. Methods Survey data from 4,224 adolescents and young adults aged 17-25 who responded to the 2005 wave questionnaire of the Growing Up Today Study were examined cross-sectionally with multivariable generalized estimating equations regression. We examined associations between sexual orientation and reproductive health care utilization as well as abnormal results with completely heterosexuals as the referent group, controlling for age, race/ethnicity, geographic region, and sexual history. Results After accounting for sociodemographics and sexual history, mostly heterosexual/bisexual females had 30% lower odds of having a Pap test within the last year and almost 40% higher odds of being diagnosed with an STI, as compared to the completely heterosexual group. Additionally, lesbians had very low odds of having a Pap test in life (OR=.13, p-value=<.0001) and having a Pap test within the last year (OR=.25, p-value=.0002), compared to completely heterosexuals. Conclusions Our study demonstrates that sexual minority adolescent and young adult women underutilize routine reproductive health screenings including Pap smears and STI tests. Providers and health educators should be aware of these disparities so that they can provide appropriate care to young women and their families and ensure that all young women receive reproductive health screening. Further research is needed to explore reasons sexual minority females are not accessing care as recommended since this may suggest opportunities to improve reproductive health screenings as well as broader health care access issues.

Sexual and Reproductive Health Indicators and Intimate Partner Violence Victimization Among Female Family Planning Clinic Patients Who Have Sex with Women and Men

“…14 Other studies of women who have sex with women, regardless of sexual identity, indicate that pregnancy 15 and STIs 16,17 are not uncommon in this population. However, studies are conflicting regarding whether sexual minority women receive similar or fewer clinic-based services for sexual and reproductive health than their heterosexual counterparts, [18][19][20] indicating that sexual minority women's reproductive and sexual healthcare needs are not well understood, despite evidence of greater sexual risk.…”

Understanding the Influence of Stigma and Medical Mistrust on Engagement in Routine Healthcare Among Black Women Who Have Sex with Women

“…It is well established that WSW and Black women report lower rates of engagement in healthcare when compared to their heterosexual and Latina or White counterparts, [32][33][34] which is reflected in the former subgroups' comparatively worse health outcomes. [35][36][37][38][39][40] These findings suggest that BWSW's unique experiences with stigma and medical mistrust are likely contributing to these disparities in seeking care, even when care is clinically necessary.…”

Families of choice and noncollegiate sororities and fraternities among lesbian and bisexual African-American women in a southern community: implications for sexual and reproductive health research

“…[7][8][9][10][11] Lack of access to appropriate care may be a particularly salient barrier in the southern USA, where attitudes towards LGBT-identified individuals are perceived to be especially unwelcoming due to the region's religious and political conservatism. 12 African-American women who have sex with women are emerging as a relatively hidden LGBT subpopulation that is at especially high risk for negative sexual health outcomes 13 as a result of their multiple structural inequalities (i.e.…”