Background: Cervical cancer is the leading causes of cancer death in women worldwide. It is preventable and, in most cases, curable, unlike other reproductive organ cancers. Though female sex workers are having higher risk of Human papillomavirus infection due to multiple sexual partners, the screening service uptake is trivial and barriers to pre cervical cancer screening among sex workers remain a few known in Ethiopia. Objective: To identify determinants of pre cervical cancer screening uptake among female sex workers in Bahir Dar City, North West Ethiopia ,2021. Methods: Institution based unmatched Case-Control study design was used from January 1 to July 30, 2021 G.C. A total of 287 (58 cases and 229 controls) 1:4 female sex workers were participated in this study. Participants were recruited with systemic random sampling method. Further as a method for data analysis descriptive statistics were used to summarize data and binary logistic regression was employed to identify determinants of pre cervical cancer screening uptake among female sex workers. Bivariate logistic regression was carried out to select candidate variables with a cut-off point<0.2 while adjusted odds ratio were used to measure the strength and significance of association. Results: Fifty-eight cases and two hundred twenty-nine controls were participated in the study. Mean 23(+/- 4SD) age of cases and controls was twenty-three. Estimated results of the model of pre cervical cancer screening uptake among female sex workers clearly demonstrated that the major reasons for not screened for cervical cancer were, Attitude(AOR= 1.463,( 1.349, 1.586),recommended to be screened (AOR=3.107,95%CI(2.507,3.852),Knowledge(AOR=7.810,(2.051,3.027), not painful procedure(AOR=1.354(1.237,1.483),harmful(AOR=1.298(1.177,1.432),prevention(AOR=1.822(1.267,2.621),Workinghour(AOR=3.297(2.530,4.295),frequency of facility visit (AOR=5.181, 95% CI:2.738,9.804) were statistically significant for cervical cancer screening uptake. Conclusions: Provider’s recommendation, history of sexually transmitted infection, frequency of facility visit and history of vaginal examination were statistically significant predictors for cervical cancer screening uptake. Encouraging female sex workers to visit facilities frequently, recommend to be screened, proper counselling before screening and awareness should be intensified on the importance of screening in order to improve acceptance. Key Words: Pre cervical cancer, screening, Female Sex workers, Barriers, Human Papillomavirus