The issue of capacity to consent to sex/sexual relations has come to the fore in recent years. It has become so important that it has risen to the highest legal echelons, with the Supreme Court having developed a ‘test’ for consent to sex in the case A Local Authority v JB (2021). This epoch-making case runs as a thread through the whole book. The foreword encapsulates the essence of the book, which considers the ‘delicate and at times controversial terrain of sex, sexuality, intimacy and their legal footholds’. It describes a ‘shifting legal landscape’ and suggests that it will be of particular use for health and social care professionals who are supporting people with cognitive impairments in relation to intimate relationships. The book comprises eight chapters in two parts (fewer than 200 pages and hence very readable): ‘1. Legal developments’ and ‘2. The law in practice’.

Part 1 includes interesting historical legal perspectives evolving into the current Mental Capacity Act (MCA) when assessing the capacity to consent to sexual relations. The chapter entitled ‘Sexual capacity: are there questions the law should not ask?’ I found to be the most engaging as a clinician. It observes that the MCA possibly hasn’t been as progressive as was hoped in this area and that historical biases persist (e.g. the tendency to be overprotective of people with cognitive or intellectual disabilities and their sexual autonomy, and paternalistic attitudes towards women). The inherent nuances and complexities in assessing capacity around sex and sexual relations are explored and, in doing so, provide advice for practical assessments that many clinicians can find to be a very abstract concept (e.g. overlapping issues of capacity to have or not have contact with others with being able or unable to consent to sexual relations). In doing so, it challenges the reader to re-evaluate their own potential biases and practice.

Part 2 concentrates more on how relevant law and policies could be reformed and how legal processes can find the balance between sexual freedom and freedom from sexual abuse to promote sexual autonomy and prosecute sexual offences. The issue of consent to sexual relations is reviewed in the wider context involving abuse and criminal acts, and human rights aspects around sexual relations and sexual expression in balancing rights with risks (i.e. developing a rights-based, person-centred approach especially in social work practice). One chapter specifically reviews people living with dementia in this context.

Helpful reflection chapters at the end of both parts elucidate key issues for clinical practice – the second reflective chapter contains helpful illustrative hypothetical practice examples. The book is thought provoking and a tour de force in terms of its depth and breadth of the research of this complex topic, helping the reader to navigate the ‘legal labyrinth of sexual capacity’.