Although the terms ‘sexual offences’ and ‘paraphilias’ are often used interchangeably, and there is overlap between them, there needs to be clarity about what each means. Sexual offences are marked by breaches of statute law, determined largely by the justice system (although an individual’s behaviour can place them at risk of law breaking). Only a proportion of sex offenders suffer from paraphilias and not all individuals with a paraphilia are sex offenders. Frequently individuals suffering from paraphilias harbour extreme sexual fantasies and urges only, or their act does not cross the threshold of involving a non-consenting individual or child. The treatment of paraphilias is not solely based on minimising risk, but also can include the aim of reducing the severe distress that an individual can feel about their extreme sexual urges. Whether people with intellectual disability are more likely to offend sexually than the general population is the subject of much research. Exploration of the range of sexual problems and potential treatments are covered.