Exploring How Staff Engage in Conversations Around Sexuality With Adults With Intellectual Disabilities: A Qualitative Systematic Review

Aims: This review explored how health and social care staff engage in sexuality-related conversations with adults with intellectual disabilities. Method: Electronic databases (PsycINFO, MEDLINE, CINAHL and Scopus) were searched from January 2006 to August 2025 following PRISMA guidelines. From the initial 1666 studies identified, a total of 23 were retained for narrative synthesis following quality assessment. Results: A total of 75 sexuality-related conversations were identified, of which 42 reflected real interactions (occurring [n = 39] or actively avoided [n = 3]) and 33 were hypothetical. Facilitators of conversations included trusting relationships, supportive organisational structures and targeted staff education. Key barriers included fear, stigma, role ambiguity and risk-averse service cultures. Findings highlighted a tension between growing recognition of sexual rights and risk-driven practice, underscoring the need for staff training, role clarity and rights-based policies to support open dialogue. Trial Registration: PROSPERO: CRD42023454984.