LGBTQ+ women's health disparities: screening gaps, coverage divides, and the mental health toll

She sat on the exam table in a hoodie, arms crossed, and told me she had skipped her last two Pap appointments. Not because she forgot. A prior clinician, after she mentioned a female partner, said she probably did not need cervical screening "if she wasn't with men." She believed him for three years. When I finally saw her, the HPV test was positive and the colposcopy showed high-grade changes that should never have waited that long.

I hear a version of that story more often than textbooks prepare you for. Lesbian and bisexual women still get HPV, still develop cervical cancer, and still need breast imaging on the same age-based schedule as anyone else with breast tissue. What differs is how often the system offers that care, recommends it correctly, or makes it feel safe enough to accept.

The numbers below are meant for a reporter, a clinic director, or another clinician to lift cleanly. Every figure is tied to a named primary source. Where the data is thinner than it should be, I say so.

Sexual identity	Any mental illness	Serious mental illness
Bisexual women	53.9%	19.5%
Lesbian women	38.7%	12.6%
Straight women	25.4%	5.9%

Source: SAMHSA, Lesbian, Gay, and Bisexual Behavioral Health: Results from the 2021 and 2022 National Surveys on Drug Use and Health. Age-adjusted estimates.

Year	LGBTQ+ identification
2017	4.5%
2020	5.6%
2021	7.1%
2022	7.2%
2023	7.6%
2024	9.3%

Source: Gallup. LGBTQ+ identification in U.S. rises to 9.3% (2024 data). Women identify as LGBTQ+ at roughly twice the rate of men in recent Gallup waves.

Cervical and breast screening gaps

Cervical screening is where the clinical and statistical stories collide most sharply. A woman who has never had sex with men can still acquire HPV and still die of a preventable cancer. USPSTF guidelines do not carve out exceptions by sexual orientation. Practice often does.

In an analysis of 2016 and 2018 BRFSS data published in Cancer Causes & Control, Lin and colleagues found that the proportion of people up to date with cervical cancer screening was 81.9% among those who identified as straight, 70.8% among those who identified as gay or lesbian, and 75.3% among those who identified as bisexual. That is an 11-point gap between straight and gay/lesbian respondents on a service that prevents cancer. Lifetime screening gaps were larger still among some Asian/Pacific Islander and Hispanic sexual-minority subgroups.

KFF's 2022 Women's Health Survey found a narrower difference on a different measure: among people assigned female at birth ages 21-64, 54% of LGBT+ respondents reported a Pap smear in the past two years, compared with 59% of non-LGBT+ respondents. The window and population differ from the BRFSS analysis, so the two numbers should not be averaged. What they share is direction: sexual-minority women are less likely to receive guideline-recommended screening.

Mechanisms recur in the literature and in clinic. Some clinicians incorrectly counsel that lesbian patients do not need Pap tests. Some patients avoid pelvic exams after prior disrespect. Some women lack a usual source of gynecologic care because they never entered the system through contraception or prenatal visits. Our review of cervical cancer and HPV screening statistics covers the national baseline; the sexual-orientation gap sits on top of those already uneven rates.

Breast cancer screening is murkier. Risk factors that track higher in some lesbian and bisexual populations (nulliparity, alcohol use, higher body mass index in some samples) would argue for more attention to mammography, not less. SAMHSA's 2021-2022 NSDUH data put past-month cigarette smoking at 25.0% among lesbian women and 27.2% among bisexual women, versus 13.8% among straight women. Heavy alcohol use was 10.9% and 9.1% versus 4.4%. Those are cancer-relevant exposures, age-adjusted. National mammography comparisons by sexual orientation are less consistent than cervical data. Some analyses find lower screening among bisexual women; others find similar rates once insurance and usual source of care are held constant. Risk-factor disparities are clearer than the screening gap itself. For the general picture, see our breast cancer screening statistics.

Insurance coverage and access

Coverage is not the whole story of access, but it is the scaffold. The Williams Institute's May 2025 analysis of pooled 2021-2023 BRFSS data found that LGBT adults are about twice as likely as non-LGBT adults to have Medicaid as their primary insurance: 13% versus 7%, or roughly 1.8 million LGBT adults. The concentration among women is sharper. Seventeen percent of cisgender lesbian and bisexual women (more than 1.2 million people) rely on Medicaid as their primary coverage, compared with 7% of non-LGBT adults and 7% of cisgender gay and bisexual men.

That pattern tracks poverty and disability rates, not a preference for public insurance. KFF's 2022 survey found LGBT+ adults less likely to hold private insurance (59% vs 64%) and more likely to have Medicaid (21% vs 16%), with similar uninsured shares overall. Having a regular doctor was slightly less common (72% vs 77%).

State Medicaid expansion changes the picture. In expansion states, only 7% of LGBT adults were uninsured in the Williams Institute analysis, versus 18% in non-expansion states. Medicaid as primary coverage was 15% versus 8%. For lesbian and bisexual women already deep in the Medicaid pool, those state decisions are whether the next mammogram or antidepressant fill is covered.

Cost still bites with a card. In the 2022 KFF survey, 29% of LGBT+ people reported problems paying medical bills in the past year. That rate is similar to non-LGBT+ adults, but against a younger age distribution and higher rates of chronic conditions and disability. Among those with bill problems, 61% said they used up all or most of their savings. That is the same cliff we document across women's healthcare access disparities; sexual-minority women hit it earlier because baseline need is higher.

Measure	Expansion states	Non-expansion states
Medicaid as primary insurance	15%	8%
Uninsured	7%	18%

Source: Williams Institute, LGBT Adults with Medicaid as Their Primary Source of Health Insurance, May 2025 (BRFSS 2021-2023).

Mental health disparities

If you take only one set of numbers from this page, take the mental health rates. SAMHSA's pooled 2021-2022 NSDUH estimates, age-adjusted to the 2000 U.S. standard population, put any mental illness in the past year at 53.9% among bisexual women, 38.7% among lesbian women, and 25.4% among straight women. Serious mental illness was 19.5%, 12.6%, and 5.9% respectively. Bisexual women were more than three times as likely as straight women to meet that threshold.

Major depressive episode followed the same gradient: 26.1% of bisexual women, 15.2% of lesbian women, and 9.1% of straight women. Serious thoughts of suicide were reported by 14.7% of bisexual women and 10.4% of lesbian women, versus 4.2% of straight women. Suicide plans were five times as common among bisexual women (5.0% vs 1.0%), and past-year attempts six times as common (2.4% vs 0.4%).

KFF's surveys land in the same range with different instruments. In the 2023 Racism, Discrimination, and Health Survey, 39% of LGBT adults described their mental health as fair or poor, versus 16% of non-LGBT adults. Fifty-four percent said they always or often felt anxious. Nearly half (46%) said there was a time in the past three years when they needed mental health services but did not get them. That is more than double the 20% non-LGBT rate. Among LGBT adults already in fair or poor mental health, forgone care rose to 68%.

The 2022 KFF Women's Health Survey found that 67% of LGBT+ people needed mental health services over the past two years, versus 39% of non-LGBT+ people. Need is high; receipt is incomplete: only about half of LGBT+ people who reported a need received care. In the separate 2023 KFF Racism, Discrimination, and Health Survey, among LGBT adults who received or tried to receive mental health services, roughly half reported difficulty finding a provider who was timely (55%), affordable (48%), insurance-accepting (49%), or able to relate to their background and experiences (51%).

Youth data make the same point earlier. CDC's 2023 Youth Risk Behavior Survey found that 41% of LGBTQ+ high school students had seriously considered suicide, versus 13% of cisgender heterosexual students. Sixty-five percent of LGBTQ+ students reported persistent sadness or hopelessness, versus 31% of cisgender heterosexual peers. Among transgender students, 52.9% seriously considered suicide and 25.9% attempted suicide in the past year, compared with 24.0% and 11.0% of cisgender female students.

These are population-level psychiatric burdens, not footnotes. They interact with substance use: sexual-minority women were two to three times as likely as straight women to report past-year marijuana use and illicit drug use other than marijuana, per the same SAMHSA brief. Co-occurring any mental illness and substance use disorder affected 22.8% of bisexual women and 16.7% of lesbian women, versus 7.1% of straight women. Our overview of women's mental health statistics sets the broader baseline; sexual-minority women sit far above it.

Discrimination in care

Discrimination is the mechanism that turns structural risk into missed appointments. KFF's 2023 survey is the cleanest recent national measure. Among adults who used health care in the past three years, 33% of LGBT adults said a doctor or provider treated them unfairly or with disrespect, compared with 15% of non-LGBT adults. Sixty-one percent of LGBT adults reported at least one specific negative experience (assumptions without asking, blame for a health problem, ignored questions, or refused pain medication), versus 31% of non-LGBT adults.

The burden is uneven. Seventy-three percent of LGBT women reported discrimination in daily life at least a few times in the past year, versus 51% of LGBT men. LGBT adults with household incomes under $40,000 were more likely than higher-income peers to report unfair treatment by a provider (41% vs 22%) and at least one negative provider experience (70% vs 51%).

Consequences follow. LGBT adults were more than twice as likely as non-LGBT adults to say a negative experience caused their health to get worse (24% vs 9%), made them less likely to seek care (39% vs 15%), or led them to switch providers (36% vs 16%). Six in ten said they prepare for insults or feel they must watch their appearance to be treated fairly at least some of the time during visits.

The 2022 KFF survey found a similar pattern on a shorter window: 45% of LGBT+ people who had visited a provider in the past two years reported at least one negative experience, and 12% reported discrimination during a visit, twice the non-LGBT+ rate. Women, younger adults, low-income respondents, and people with disabilities reported the highest rates within the LGBT+ sample. Clinically, that is the day a patient stops disclosing partners or stops coming in until something is acute. For related patterns in reproductive care, see our summary of sexual health and STI statistics for women.

Experience (past 3 years)	LGBT adults	Non-LGBT adults
Treated unfairly or with disrespect by a provider	33%	15%
At least one negative provider experience	61%	31%
Negative experience made them less likely to seek care	39%	15%
Negative experience caused health to get worse	24%	9%
Switched providers after a negative experience	36%	16%

Source: KFF Survey of Racism, Discrimination, and Health, 2023 (report published April 2024). Among adults who used health care in the past three years where applicable.

Data-collection gaps

Every section above has a caveat that should not be optional: sexual orientation and gender identity still are not collected uniformly across U.S. health surveys. The CDC's BRFSS has offered an optional SOGI module since 2014. States choose whether to field it. The Williams Institute notes that adoption grew from about 20 states near the module's introduction to 35 states by 2022. That is progress, still short of national coverage. Healthy People 2030 objective LGBT-04 set a target of 55 jurisdictions using the standard module.

Missingness is not only about which states opt in. Jesdale's 2021 analysis in the American Journal of Preventive Medicine estimated that in 2014-2019, 56% of sexual-orientation data and 55% of gender-identity data in BRFSS were effectively missing once non-adopting states and item nonresponse were counted. "National" LGBT health estimates often rest on a large but incomplete map.

Federal policy since early 2025 has added uncertainty. Reporting based on CDC communications indicates the agency will no longer process transgender identity data from BRFSS, while sexual-orientation processing continues. Gender-identity fields have been removed or relabeled in some public files. Subgroup estimates for transgender women, who already sit at the sharp end of many disparities, become harder to produce from the largest continuous health survey in the country.

NSDUH, the source of the mental-health figures above, only recently expanded how it asks sex, gender identity, and sexual identity. The 2021-2022 LGB brief used a binary sex measure and adult-only sexual identity; transgender-specific estimates were not in that report. The 2023 survey redesigned those items, so year-to-year comparability will take time.

Meanwhile the population those systems try to measure is growing, especially among women. Gallup put LGBTQ+ identification at 9.3% of U.S. adults in 2024, up from 4.5% in 2017. Women identify as LGBTQ+ at roughly twice the rate of men in recent waves, driven largely by bisexual identification among younger cohorts. A larger population, incomplete surveillance, and persistent disparities is a combination public health systems usually treat as urgent. The data infrastructure still lags.

For readers navigating care now: ask for guideline-based cervical and breast screening regardless of partner gender, and use tools like our period calculator and ovulation calculator as ordinary reproductive-health aids. The clinical standard does not require a different anatomy. It requires the same standard without a thinner set of assumptions.

Frequently asked questions about LGBTQ+ women's health disparities

Do lesbian women need Pap smears?

Yes. Cervical cancer screening guidelines apply by age and cervix status, not by partner gender. HPV transmits between women. BRFSS analyses show gay/lesbian respondents less likely to be up to date on screening (70.8%) than straight respondents (81.9%). Skipping screening because of sexual orientation is not supported by evidence or by USPSTF recommendations.

How common is mental illness among bisexual women?

According to SAMHSA's 2021-2022 NSDUH estimates, 53.9% of bisexual women had any mental illness in the past year and 19.5% had serious mental illness, compared with 25.4% and 5.9% of straight women. Major depressive episode affected 26.1% of bisexual women versus 9.1% of straight women in the same period.

How often do LGBT adults experience discrimination in health care?

In KFF's 2023 survey, 33% of LGBT adults who used care in the past three years reported unfair or disrespectful treatment by a provider, twice the 15% rate among non-LGBT adults. Sixty-one percent reported at least one negative provider experience such as assumptions, blame, ignored questions, or refused pain medication.

Are LGBTQ+ women more likely to rely on Medicaid?

Yes. The Williams Institute's analysis of 2021-2023 BRFSS data found that 17% of cisgender lesbian and bisexual women rely on Medicaid as their primary insurance (more than 1.2 million people), compared with 7% of non-LGBT adults. Overall, 13% of LGBT adults have Medicaid as primary coverage versus 7% of non-LGBT adults.

Why are LGBTQ+ health statistics incomplete?

Sexual orientation and gender identity questions remain optional on the CDC's BRFSS, so not all states field them every year. Adoption rose toward 35 states by 2022 but still falls short of full national coverage. Recent federal changes limiting processing of gender-identity data further constrain transgender-specific estimates from major surveys.

Do discrimination experiences affect whether women seek care?

They do. KFF found that 39% of LGBT adults said a negative health care experience made them less likely to seek care, and 24% said it caused their health to get worse. Those rates are more than double the rates among non-LGBT adults (15% and 9%). Avoidance after a bad visit is one pathway from stigma to delayed cancer screening and untreated mental illness.