There is a significantly higher rate of childhood sexual abuse among individuals who identify as lesbian, gay, bisexual, or queer. We describe how being a survivor of childhood sexual abuse can later affect adult sexual identity formation by examining it through the intersection of gender, race, and sexual orientation. Adult lesbian, gay, bisexual, and queer abuse survivors may experience unique clinical challenges while healing from this type of traumatic experience and developing a healthy lesbian, gay, bisexual, or queer identity. We recommend a multicultural clinical approach for family therapists in order to best treat this vulnerable population.