This review examines the literature on sex and relationship issues in the context of serious and persistent mental health problems. It identifies gaps in the research and highlights key issues needing further investigation. The available published documents have been identified, which contain information, ideas, data and evidence on the topic. A critical analysis of the subject, through the examination of the various documents, is provided. The main themes that emerged included HIV/AIDS, medication and sexual dysfunction, sexuality needs, intimate relationships, family planning, policies and sex education. Several subthemes are discussed and include needs assessment, stigma and loneliness. The key findings highlight the lack of systematic studies in the UK, especially regarding the subjective views of patients in determining need and the subsequent development of appropriate plans of care. The author argues that future mental health research needs to go beyond investigating perceived ‘risky’ behaviours and should include potential therapeutic responses in all areas of sexuality. Further recommendations are made in terms of nurse education particularly the inclusion of psychosexual aspects in future pre- and postregistration curricula. This paper may be of interest to service users, mental health practitioners working alongside people with serious and persistent mental health problems as well as educators, researchers and policy makers.