Abstract: In this theoretical chapter, I offer a new framework for describing how sexualities come into existence through the everyday labor of biomedical practice across scales in the United States healthcare system. I ask: How do sexualities come into existence as actionable entities or constructs in contemporary U.S. healthcare? How does this complex collection of processes shape the constitution of sexual realities? An interdisciplinary constellation of scholars are often at loggerheads over how to answer these questions. One group in the history, anthropology, and sociology of sexuality argues that sexualities emerge and stabilize through relational processes of conceptual uptake and exchange between individuals, communities, and institutions. Another cohort, mostly in queer theory, argues that sexuality constitutes a kind of radical instability, with sexual acts and queerness standing in for pure negativity, wild unknowability, or utopian transcendence of the knowable. In another vein, scholars who use constructivist approaches to study science, technology, and medicine have developed powerful tools to describe how technoscientific practices mobilize physical materials, digital tools, and epistemic frames to produce and sustain realities in conditions where the constitutive elements of those realities actively resist coherence. In an explicit move to break through epistemological blockages in queer studies, social scientists have recently started to co-deploy methods from sexuality studies and Science and Technology Studies (STS) to describe how biomedical methods produce sexualities as tangible entities with varying degrees of spatial, temporal, and disciplinary durability (Race 2016; Waidzunas and Epstein 2016). My dissertation, “Making Sex Real,” contributes to this project by showing how assemblages of human and nonhuman actors translate physical materials, technologies, and data into temporarily stable entities that become perceptible and provisionally actionable as sexualities only in specific sociotechnical and epistemic arrangements. Drawing on data from extensive health policy research and over a year of fieldwork with practitioners in HIV/AIDS, LGBTQ health, and health information technology (IT) in the United States and metropolitan Atlanta, I show that, in health contexts, sexualities are enacted, materialized, or, “built up and sustained” into a kind of temporary existence in biomedical milieus through processes of technosexual dramatization (Mol 2001: vii-vii; Barad 1998, 2007; Murphy 2006; Law 2004: 13). Technosexual dramas produce what I call situated sexual realities, following historian of sexuality Robert Padgug and feminist STS scholar Donna Haraway (1979: 10; 1991[1988]: 188-96).