Homosexually active men and women are no more immune than anyone else from various types of sexual dysfunction and underlying psychopathology. Intimacy fears and conflicts, ignorance, alcohol and drug dependence and relationship issues exemplify the type of issues influencing dysfunction regardless of sexual orientation, although membership of a stigmatized minority sexuality may exacerbate causes of sexual dysfunction. The effects of discordant lifestyle and identity, homosexual identity formation, dysphoria and internalized homophobia on sexual functioning are three examples of these factors of specific relevance to being homosexual in this culture. The effects of AIDS, difficulties arising from the mechanics of safer sex and the psychosexual effects of oppression on healthy sexual functioning all indicate how factors important to (but not caused by) minority sexuality status may influence sexuality functioning. The importance of neither perceiving homosexuality solely in terms of pathology on the one hand, nor refusing to recognize unhealthy sexual functioning on the other, is emphasized throughout. Models of sexuality must be inclusive, positive and communicated to the client if future sexual dysfunction is to be limited. Finally, the role of the therapist in community development, as well as individual intervention, is addressed. Primary health care interventions are required not only to address the specific issues affecting homosexual men and women, but also to promote a more positive approach to sexuality for all.