Sexual distress can also occur in situations of gender
and sexual identity. Lesbian, gay, bisexual and
transsexual identity issues can include:

• Feeling uncomfortable with gay, lesbian
  or bisexual stereotypes.
  
  
• Situations of societal pressures on same
  sex relationships
  
  
• Differences and / or difficulties in sexual expression
  
  
• Legal implications and adoption planning issues
  about having children
  
  
• Wider relationship issues such as coming out as
  a same sex couple, or relationship breakdowns.
  
  
• Gender identity and sexuality changes or fluidity

Alternative sexual expression and relationships have their
own set of considerations such as:

• Making safe, sane and consensual choices
  
  
• Incorporating others into a loving relationship
  or being polymogymous
  
  
• Incorporating other forms of sexual expression into sex,
  such as, power play, bondage and discipline or cross dressing.