David Thompson, Michelle McCarthy

Sex and the 3 Rs: Rights, Risks and Responsibilities

Training pack

A sex education pack for working with people with learning disabilities

Sex and the 3 Rs: Rights, Risks and Responsibilities (4th edition) is a comprehensive guide to teaching sex education to people with learning disabilities.



Sex and the 3 Rs: Rights, Risks and Responsibilities is a sex education resource that provides a framework for staff to undertake sex education work which acknowledges the realities of sexual relationships for many people with learning disabilities. An extensive range of issues relating to sexuality are discussed with suggestions for assessment, service responses to, and work around the issue. The pack directly tackles difficult subjects, including pornography, sexual abuse of children, consent in relationships and safer sex.

This fourth edition is fully revised and updated with additional material covering recent policy and legislative changes. Like its predecessor, this training resource is aimed primarily at those working with adults with learning disabilities, however parts of it can be adapted for use with younger people.

Sex and the 3 Rs has been updated as a result of industry changes that are currently impacting upon the sexual lives of people with learning disabilities and the increasing amount of time many people spend online which subsequently, then affects their personal, social and sexual lives. This new fourth edition gives some ideas on how to support people with learning disabilities to safely access online pornography and engage in ‘sexting’.

Fully revised fourth edition; includes photocopiable line drawings and comprehensive guide to teaching sex education to people with learning disabilities.





Sex and the 3 Rs: Rights, Risks and Responsibilities (4th edition) will be of particular interest to direct care staff and managers in residential, day and community services; all members of community learning disability team; sex education workers;health promotion workers and health facilitators.

This training resource will benefit all health and social care staff, including those in the private or voluntary sector. It may also be helpful for family members and people with learning disabilities in peer education.


ISBN: 9781911028406
Publication: 17 October 2016

Section 1: Contexts

  • 1.1: The Law
  • 1.2: Race, culture, ethnicity and religion
  • 1.3: The environment and opportunities for relationships
  • 1.4: Syndromes, physical disability and medication
  • 1.5: Confidentiality
  • 1.6: Guidelines, policies and care plans
  • 1.7: Staff supervision and safeguards

Section 2: Individual work

  • 2. 1: Why do individual work?
  • 2.2: Who should do the work?
  • 2.3: The importance of trust
  • 2.4: Outside help
  • 2.5: Sensitivity to sexual lifestyles
  • 2.6: Does the individual want to do the work?
  • 2.7: Where should individual work take place?
  • 2.8: Length and time
  • 2.9: Communication
  • 2.10: The implications of talking about yourself
  • 2.11: Accepting the reality of people’s lives
  • 2.12: Skills required
  • 2.13: Supervision
  • 2.14: Limits
  • 2.15: Evaluating individual work

Section 3: Group work

  • 3.1: Possibilities and limits
  • 3.2: Single-sex or mixed groups?
  • 3.3: Facilitators and co-facilitators
  • 3.4: Group size
  • 3.5: Practical arrangements
  • 3.6: Time span of groups
  • 3.7: Finding group members
  • 3.8: The abilities of group members
  • 3.9: Confidentiality
  • 3.10: Methods
  • 3.11: Setting the agenda.
  • 3.12: A suggested outline for a 14-week course

Section 4: Issues

  • 4.1: General sex education
  • 4.2: Appropriate and inappropriate masturbation
  • 4.3: How to masturbate
  • 4.4: Menstruation
  • 4.5: Menopause
  • 4.6: Sensitivity in relationships
  • 4.7: Assertiveness and saying no
  • 4.8: Consent
  • 4.9: Sex between people of different abilities
  • 4.10: Men having sex with men
  • 4.11: Women having sex with women
  • 4.12: Women wanting and having boyfriends
  • 4.13: Women having sex with men
  • 4.14: Men wanting and having girlfriends
  • 4.15: Men having sex with women
  • 4.16: People being sexually abused
  • 4.17: Men with learning disabilities who sexually abuse
  • 4.18: Sexual risk to children
  • 4.19: Sexually transmitted diseases and safer sex
  • 4.20: Men with learning disabilities having sex with men in public toilets
  • 4.21: Sexual and reproductive health screening
  • 4.22: Pornography and the internet
  • 4.23: Access to sex workers
  • 4.24: Reproduction
  • 4.25: Contraception
  • 4.26: Marriage and civil partnerships
  • 4.27: Forced marriage
  • 4.28: Domestic violence
  • 4.29: ‘Mate’ crime
  • 4.30: Parenting
  • 4.31: Abortion
  • 4.32: Men with learning disabilities cross-dressing and other unconventional sexual behaviours

Section 5: Notes on the pictures

  • 5.1: Considerations for using the pictures
  • 5.2: Description of each picture and ideas for use
  • 5.3: Catalogue of pictures

Section 6: Resources and organisations

  • Resources
  • Organisations


Michelle McCarthy has worked with people with learning disabilities throughout her career. She worked first in residential care, then trained as a social worker. Her work in the area of sexuality began with David Thompson, working on a specialist sex education service. Since 1993, she has worked at the Tizard Centre, University of Kent where she is a Reader in learning disabilities. Her academic and practice-based work involves all matters relating to sexuality, but she has a particular interest in working with women with learning disabilities on issues of sexual abuse, sexual and reproductive health and domestic violence. She has published widely in these fields. This includes a number of resource packs with Pavilion, but also books, academic and professional journals.

David Thompson spent almost ten years working directly with people with learning disabilities on sexual issues. This experience informed the development of this package and his PhD. Since then he has had a variety of practice development roles including: support for family carers and people with learning disabilities as they age, advocacy and the Mental Capacity Act (2005). While turning 50 he trained to be a mental health nurse and then worked as the adult safeguarding nursing lead for Hounslow and Richmond Community Healthcare NHS Trust. During this time he was also vice chair of the Ann Craft Trust: a national charity to protect children and adults with learning disabilities at risk of abuse. He recently relocated to Australia with his civil partner.


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