Background This article discusses what happens when normative ‘global’ discourses of rights and individuated sexual identity confront the messiness of ‘local’ realities. It considers the tensions that emerge when the relationship between sexual and social identities is not obvious and the implications of such tensions for public health and sexual rights activism. These questions are addressed through debates over the naming of male-to-male sexualities and desires in the context of globalization and the growth of a large NGO (non-governmental organization) sector in urban Bangladesh. Methods The material in the paper draws on a research project undertaken in 2008-9 in Dhaka, Bangladesh. A fundamental objective was to produce a contextualized understanding of sexuality in Dhaka city. Methods used included structured interviews, focus group discussions and informal conversations with a range of participants (students, factory workers, public health professionals and sexual minorities). The aim was to generate a conceptual and analytical framework around sexuality and rights rather than to undertake an empirical survey of any one population. Results As descriptors, globalized identity categories such as Men who have Sex with Men (MSM), used by public health providers, the state and donors; and gay/lesbian, invoked by human rights activists and transnational NGOs, are too narrow to capture the fluid and highly context-specific ways in which gender and sexually nonconforming persons understand themselves in Bangladesh. Further, class position mediates to a significant degree the reception, appropriation or rejection of transnational categories such as MSM and Lesbian, Gay, Bisexual, Transgender (LGBT). The tension is reflected in the sometimes fraught relations between service providers to MSM, the people they serve and an emerging group who identify as LGBT. Conclusion A simple politics of recognition will be inadequate to the task of promoting health and human rights for all; such a strategy would effectively exclude individuals who do not necessarily connect their sexual practices with a specific sexual or social identity.