Research and clinical work on sexual functioning in men has traditionally focused on the presence or absence of erectile dysfunction (ED) or the inability to maintain an erection sufficient for satisfactory sexual performance. However, for men who have sex with men (MSM), receptive anal intercourse is a common form of sexual expression. Existing work on men’s sexual dysfunction does not effectively address receptive anal sex functioning, and there is a need to understand how stressors can impact this common sexual behavior. The goal of the present study was to understand how stressors can impact erective and receptive anal sex functioning among MSM. In the present study, we hypothesized that minority stress (as operationalized by integrating identity management and heterosexual self-presentation) would have an impact on MSM’s sexual functioning overall and adapted a previous measure of sexual dysfunction (International Index of Erectile Functioning) to better assess this relationship. Data were collected from 228 men (Mage = 31.74, SD = 9.41); exploratory factor analysis was used to create a new measure of sexual functioning, and regression analyses were used to examine the relationships between heterosexual self-presentation and identity management and sexual functioning. Results demonstrated that higher heterosexual self-presentation was associated with more functional impairment in erectile function and receptive anal sex functioning as well as use of functional enhancement medications or substances. The results of the present study extend extant work on minority stress to sexual functioning of MSM and are relevant to the sexual health concerns of MSM.