title: Sexual orientation and sexual health services utilization among women in the United States.
abstract: Although sexual minority women are at risk of sexually transmitted infections (STIs) and cervical cancer, few nationally representative studies have assessed sexual orientation disparities in sexual health care among women. Using data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth, which provide a national probability sample of U.S. women aged 15-44years (N=11,300), we used multivariable logistic regression to examine the associations between sexual behavior and sexual identity (modeled separately) and STI testing in the past year, Pap test use in the last 3years, lifetime HIV testing, and lifetime human papillomavirus (HPV) testing. Women with male and female lifetime sexual partners had higher adjusted odds of being tested for STIs ([odds ratio:] 1.61; [95% confidence interval:] 1.37-1.89), HIV (1.66; 1.29-2.14), and HPV (1.79; 1.41-2.25) and similar adjusted odds of obtaining a Pap test (0.98; 0.76-1.27) than women with only male lifetime sexual partners. Self-identified bisexual women had higher adjusted odds of obtaining an STI (1.43; 1.10-1.86) and HIV (1.69; 1.24-2.30) test but lower adjusted odds of obtaining a Pap test in the last 3years (0.66; 0.47-0.93) than heterosexual-identified women. Women with only female lifetime sexual partners had lower adjusted odds of receiving an STI (0.14; 0.07-0.28) and Pap (0.10; 0.03-0.27) test than women with only male lifetime sexual partners. Results comparing self-identified lesbian and heterosexual women were similar. Health care facilities should monitor and address sexual orientation disparities in women's sexual health care and ensure the provision of high-quality sexual health services to all women.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States. Electronic address: magenor@hpsh.harvard.edu.
authors.forename: Madina
authors.initials: M
authors.lastname: Agénor
authors.affiliation: Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Muzny
authors.affiliation: Center for Health Promotion and Prevention Research, Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Schick
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States.
authors.forename: Erika L
authors.initials: EL
authors.lastname: Austin
authors.affiliation: Division of Medicine, Harvard Medical School, Boston, MA, United States; Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; The Fenway Institute, Fenway Health, Boston, MA, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Potter
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D065006:Papanicolaou Test / Q000379:methods; D060728:Reproductive Health; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D000072339:Sexual and Gender Minorities / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control
keywords: Health care disparities; Sexual health services; Sexual orientation; Women