Although one in three U.S. contraceptive clients identify as something other than heterosexual, research has overlooked associations between sexual identity and experiences of provider-based contraceptive coercion - that is, pressure from a healthcare provider to use or not use birth control. In 2023, we used the online Prolific panel to survey U.S. reproductive-age people assigned female at birth about their contraceptive care (N = 1,399; mean age = 32.6, SD = 8.24). We assessed differences in contraceptive care preferences and coercion across sexual identities and used open-ended survey responses to contextualize participants' contraceptive coercion experiences. More than one-third (36%) of the sample identified as lesbian/gay, bisexual, asexual, pansexual, queer, questioning, or preferred to self-identify (hereafter LGBQ+). Compared to heterosexual participants, LGBQ+ participants were more likely to experience misalignment in how often they would like contraceptive counseling versus how often they received it. Among those who ever received contraceptive counseling (n = 1,197), LGBQ+ individuals were also more likely than heterosexuals to experience pressure to use contraception. Open-ended responses revealed LGBQ+ clients' experiences with heteronormative assumptions during contraceptive care. Healthcare systems and providers must provide patient-centered contraceptive care to all individuals, with attention to how sexual identity can shape contraceptive needs.