INTRODUCTION: Black sexual and gender minoritized (SGM) people assigned female at birth (AFAB) face notable barriers to cervical cancer screening, including racism, heterosexism, and cisgenderism. Although weight-based discrimination is prevalent in the United States and may compound other forms of discrimination, no study has examined the association between weight-based discrimination in health care settings and Pap test use among Black SGM AFAB. MATERIALS AND METHODS: We conducted a cross-sectional online survey among Black SGM AFAB adults aged 18-45 years ( = 135) and used multivariable logistic modeling to analyze the association between weight-based health care discrimination and Pap test use, adjusting for demographic, socioeconomic, and health care factors. RESULTS: Approximately one quarter (27.5%; = 33) of respondents eligible for a Pap test had ever experienced weight-based health care discrimination. Moreover, 63.3% ( = 76) and 45% ( = 54) of respondents had ever received a Pap test in their lifetime and in the last 3 years, respectively. Respondents who had experienced weight-based health care discrimination had significantly lower adjusted odds of having ever received a Pap test in their lifetime (odds ratio [OR] = 0.10; 95% confidence interval [CI]: 0.02-0.40) and in the last 3 years (OR = 0.07; CI: 0.01-0.31) compared with those who had never experienced such discrimination. DISCUSSION: Additional research is needed to elucidate the unique experiences of specific subgroups of Black SGM people and to inform policies, norms, and practices that mitigate the occurrence and effects of weight-based health care discrimination among Black SGM people in the context of cervical cancer screening and other health services.