Limited research has examined the romantic relationships of lesbian, gay, bisexual, and transgender (LGBT) youth despite evidence of relationship-oriented risks, including STI/HIV infection, unplanned pregnancy, and interpersonal violence. In efforts to inform future dyadic sexual health interventions for LGBT youth, this couple-based study aimed to identify the most salient sexual and relationship concerns of young same-sex couples and to assess their preferences for intervention content and format. Participants were a subset 36 young, racially and ethnically diverse, same-sex couples (N = 72 individuals) recruited from two ongoing longitudinal studies. Interviews were coded using a constant comparison method, and a process of inductive and deductive thematic analysis was used to interpret the data. The analysis yielded the following intervention themes: addressing sexual risk and protective behaviors, improving communication, coping with family and relationship violence, and identifying role models and sources of support. The couples reported a clear preference for small group interventions, and many recommended a mixed format approach for intervention delivery (i.e., including dyadic and online sessions). Additionally, recommendations for participant recruitment included a combination of Internet-based and social network referrals.