Compared to heterosexual youth, gay, lesbian, bisexual, and questioning (GLBQ) adolescents engage disproportionately in a variety of health risk behaviors and are at risk for numerous negative health outcomes. Adolescents reporting same-sex sexual attraction, romantic relationships, and sexual experience are also at increased risk, regardless of self-identified sexual orientation. While adolescents feel it is important to discuss sexuality with primary care providers, they are unlikely to initiate discussion about sexuality or to openly disclose GLBQ sexual orientation to their providers. Primary care providers should identify GLBQ youth to increase delivery of targeted preventive health services to this at-risk population. However, providers do not routinely address sexual orientation in their clinical encounters with adolescents, and the majority of GLBQ youth are not identified in the primary care setting. To better serve the needs of this population, providers should initiate open, sensitive, nonjudgmental, and confidential discussion of sexuality with all adolescents. Providers should inquire about sexual orientation, sexual attraction, romantic relationships, and sexual partners.