Journal of Urban Health

, Volume 83, Issue 5, pp 970–979 | Cite as

Health Care Access and Utilization among Women Who Have Sex with Women: Sexual Behavior and Identity

  • Bonnie D. KerkerEmail author
  • Farzad Mostashari
  • Lorna Thorpe


Past research has shown that women who either have sex with women or who identify as lesbian access less preventive health care than other women. However, previous studies have generally relied on convenience samples and have not examined the multiple associations of sexual identity, behavior and health care access/utilization. Unlike other studies, we used a multi-lingual population-based survey in New York City to examine the use of Pap tests and mammograms, as well as health care coverage and the use of primary care providers, among women who have sex with women and by sexual identity status. We found that women who had sex with women (WSW) were less likely to have had a Pap test in the past 3 years (66 vs. 80%, p<0.0001) or a mammogram in the past 2 years (53 vs. 73%, p=0.0009) than other women. After adjusting for health insurance coverage and other factors, WSW were ten times [adjusted odds ratio (AOR), 9.8, 95% confidence interval (CI), 4.2, 22.9] and four times (AOR, 4.0, 95% CI 1.3, 12.0) more likely than non-WSW to not have received a timely Pap test or mammogram, respectively. Women whose behavior and identity were concordant were more likely to access Pap tests and mammograms than those whose behavior and identity were discordant. For example, WSW who identified as lesbians were more likely to have received timely Pap tests (97 vs. 48%, p<0.0001) and mammograms (86 vs. 42%, p=0.0007) than those who identified as heterosexual. Given the current screening recommendations for Pap tests and mammograms, provider counseling and public health messages should be inclusive of women who have sex with women, including those who have sex with women but identify as heterosexual.


Health care access Health care utilization Mammogram Pap test Preventive care Random digit dial Sexual behavior Sexual identity Stratified sample Women who have sex with women. 


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Copyright information

© The New York Academy of Medicine 2006

Authors and Affiliations

  • Bonnie D. Kerker
    • 1
  • Farzad Mostashari
    • 1
  • Lorna Thorpe
    • 1
  1. 1.NYC Department of Health and Mental Hygiene, Division of EpidemiologyBureau of Epidemiology ServicesNew YorkUSA

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