Background: People with intellectual disability, as well as people with dementia or mental health disability, are vulnerable to sexual abuse and may lack the capacity to give valid consent to medical treatment. Their reproductive choices may be limited by their support needs, by social pressures or by sterilisation at a young age. Objective: This article uses case vignettes to illustrate key areas in dealing with sexual and reproductive health, and consent issues for people with intellectual disability. It also provides brief guidelines for assessing capacity to consent, and procedures to follow when there is no, or uncertain, capacity. Discussion: People with intellectual disability require education to help them resist abuse, and advocacy to ensure that their environment protects them. They require support and education when making reproductive choices and health care decisions. In cases where they do not have the capacity for informed consent, a substitute decision maker is required.