In “Notorious C.H.O.,” comedian Margaret Cho makes a keen observation about the S&M scene, namely how closely and disturbingly linked it is with “Star Trek” geeks and Renaissance fairs. It’s a hilarious insight told with the sharp, world-weary snap that Cho has perfected.

But not all of Cho’s comedy is observational. True to her previous, funnier film, “I’m the One That I Want,” this is a form of self-therapy. Exorcising her past, her family, her shortcomings and her triumphs from within a swaggering body that’s as comfortable in its skin as it is in telling everyone how uncomfortable it can be, Cho is determined to let the world know she’s just fine the way she is, thank you. And if you don’t like it, tough.

Filmed in Seattle during her 37-city tour last year, “Notorious C.H.O.” opens with a stock lovefest. Cho has seriously loyal fans, and they gush rhapsodic about their favorite comedian and survivor. A new kind of gay icon, Cho seems as much a lesbian idol as a gay man’s diva. She’s a drag queen without the feathers and makeup, a lesbian in platforms and lipstick, and the bossiest girl on the playground all rolled into one. And she’s undeniably funny.

Like Eddie Murphy’s “Raw,” “Notorious C.H.O.” is Cho’s blue film. More sex-oriented than her rising-from-the-bottom-of-the-drug-heap “I’m the One That I Want,” this film covers everything from bisexuality (including her fondness for lesbians who look like John Goodman) to finding her G-spot (a tired subject). She even brings sex into Ground Zero, discussing the sexual favors she performed for rescue workers. “You find out about yourself in times of crisis,” she says. “That’s a triumph of the human spirit.” She also, of course, does her famous impersonation of her mother.

Cho switches into a too-long take on her colonic irrigation at a Los Angeles health spa. Imitating her colonic therapist in an airhead voice, she’s not the most inventive or interesting. But when switching to a discussion on relationships, particularly the horror when they’re about to end and you’re the only one who knows it, Cho’s on top again. As she rambles crudely but casually about all the bothersome sexual situations of a relationship ready to break, you can’t help but laugh at the explicit detail. What she says is all so pathetically real.

And feeling pathetic yet proud seems to be Cho’s patent. Taking her childhood dreams of watching the TV show “M*A*S*H” and, in her own joke, hoping that one day she, too, could be an extra, she creates at her worst long-winded screeds on “survival” and, at her best, a strutting confidence born of misery.