"Midnight Cowboy," released in 1969, was controversial for several reasons. It featured explicit themes, including sexuality, drug use, and the struggles of marginalized individuals in New York City. The film's portrayal of a homosexual relationship between its main characters, Joe Buck and Ratso Rizzo, challenged societal norms of the time. Additionally, it was the first and only X-rated film to win the Academy Award for Best Picture, sparking debates about censorship and the boundaries of acceptable content in mainstream cinema.

"Midnight Cowboy," released in 1969, was initially rated X by the Motion Picture Association of America due to its explicit content, including themes of sexuality, drug use, and the portrayal of urban life. The film's graphic representation of these themes led to controversy, prompting it to be banned in some locations. However, it was later re-evaluated, and in 1971, it became the first X-rated film to win the Academy Award for Best Picture. Over time, its cultural significance has been recognized, and it has since been re-rated as R.

"Midnight Cowboy," directed by John Schlesinger and released in 1969, is often considered a queer film due to its exploration of sexuality, loneliness, and connection between characters. The relationship between the two leads, Joe Buck and Ratso Rizzo, transcends traditional friendship, hinting at emotional and sexual undertones. The film addresses themes of alienation and identity within the context of 1960s America, making it significant in LGBTQ+ cinema. Its nuanced portrayal of male intimacy and vulnerability contributes to its queer interpretation.

In "Midnight Cowboy," the character Ratso Rizzo, played by Dustin Hoffman, suffers from tuberculosis, which is a chronic illness that affects the lungs. His condition is depicted throughout the film, highlighting his frailty and struggles as he navigates life on the streets of New York City. Ratso's illness serves as a significant element in the story, emphasizing themes of survival, friendship, and the harsh realities of life in the urban landscape.