SummaryIssues such as sexual dysfunction, hypersexuality, risky sexual behaviour and mental capacity in relation to sexual activities arise frequently in people with psychosis. However, they may not always be given a priority in doctor-patient interactions, despite their often critical importance from the patient's perspective. Having a working knowledge of these topics may improve the quality of psychiatric intervention for people with severe mental illness. This article explores these topics, with a particular emphasis on assessment and management in everyday practice.