Let's voice it- bridging the cervical screening health inequality among sexual minority women

King's Fund defines health inequalities as 'avoidable, unfair and systematic differences in health between different groups of people'.1 This includes sexual minority women (individuals who identify as lesbian, bisexual, transgender, Two-Spirit, queer, and/or intersex). Their identification has huge negative impacts on the healthcare they receive. Cervical screening is a national programme to detect cervical cancers using smears. This uptake is lower among this minority (15% were eligible but did not receive), compared to the general population(7%).2 This is a global issue. It's time to improve. To highlight the main contributory factors to healthcare inequalities affecting sexual minority women in cervical screening. To identify potential methods to minimise them. Literature review conducted using relevant keywords on electronic scientific databases (Medline, PubMed, Embase and Cochrane Library) to obtain peer-reviewed articles in English from 2008 to 2022. Inclusion and exclusion criteria were exercised to acquire the pertinent data. Thematic Analysis of Barriers (three levels)-Healthcare professionals (HCPs), Client and the NHS Lack of knowledge among HCPs and Clients due to new challenges like anatomical changes after using hormones. There is provider misunderstood/confusion-causing recommendations too, like cervical smears being only for heterosexual women.2 Time constraints- Smears are usually done by nurses with limited clinic timeslots. Discrimination- Personal prejudice/ideologies or a lack of situational awareness among staff, leads to unconscious bias. This generates emotional barriers like anxiety, fear, embarrassment and clients' lack of trust.3 Psychological issues- Differences between self-image and perceived self-identity in the younger population.4 Lack of a national cancer screening database for this minority poses communication challenges. Potential solutions Education/training HCPs taught agreed terminology for sexual minorities, using appropriate pronouns pertaining to client preference,5 surgically/hormonally changed anatomy teaching, mandatory training modules on inclusive culture to overcome discrimination and bias. Client- School nurse education and adolescent student education on cervical screening being 'for anyone with a cervix, irrespective of their sexual orientation/behaviour'. NHS system- Creating a purpose-oriented cancer screening information leaflet at a national level. Service improvement Psychosexual social support in Primary care, reduces dysphoria Increased time slots for cervical smears, available at request with readily available doctor input Increase healthcare job opportunities for sexual minority women to create a more comfortable, diverse environment Mobile screening healthcare vans- opportunistic smears Transgender service can create a new National Collaborative 'Healthcare Protected Characteristics Database' accessible to Primary care services- for the presence of a cervix and sexual orientation to send screening smear test information and appointments. This should be updated regularly to reduce missing invitations. Develop a national standardised digital app to promote cervical screening amongst younger people with understandable scientific evidence. These improvements would decrease embarrassment and language barriers among this minority. This is of high interest to explore further Empowering individualised care should be provided (e.g. self-testing kits). More research should be conducted to test efficacy and efficiency of these solutions towards equitable, prudent healthcare. This emerging healthcare issue must be addressed promptly and sensitively to deliver healthcare aligning with the NHS's core values to sexual minority women.