Exiting empirical data on female homosexuality demonstrate women who have sex with women engage in risky sexual behaviors and practices that put them at risk of woman-to-woman transmitted infections and other same-sex sex health-related problems. However, the level of risk varies among women in same-sex relationship pending on sexual risk behaviors they engage in, posing differentiated perceived and real health needs. I present perceived health needs among women who have sex with women in Tanzania. Four qualitative methods were used to collect data: in-depth interviews, focus group discussions, collecting participants’ life stories and observations. Data analysis deployed thematic approach where open systematic coding of data in the participants’ language and combining emerging emic concepts with preconceived theoretical constructs was used. With the exception of the women who identify transgender men or tomboys, women interviewed reported having similar primary and specialized health needs like their counterparts. Transgender men reported in need of affordable sex toys, lubricants and trusted healthcare providers skilled to manage their specific health needs. Deep-rooted belief that homosexual females are at low risk of HIV and other STIs coupled with a lack of awareness of the link between female same-sex sexual practices and diseases informed the poor risk perception demonstrated by women studied. I recommend for larger ethnographic and multidisciplinary (longitudinal/cohort) studies, with different designs and nationally representative samples to assess women who have sex with women’s health needs and wellbeing in the Tanzania context.