For people with disabilities in the UK, Lorna Couldrick and Alex Cowan’s chapter shows, the situation is in many ways similar to women living with HIV: there is a presumption that people with disabilities are, or ought to be, asexual and little open recognition of their sexual needs and desires. Couldrick and Cowan point out that this lack of acknowledgement of the role of sex and sexuality in the lives of people with disabilities can be exacerbated by health and social care practices, arguing that, ‘the very delivery of health and social care may undermine the sexual health of disabled people and perpetuate the myth that if you are disabled, intimacy and sex no longer matters.’ This chapter begins with a little information on the context of the authors’ experiences which underpin their positions. Then, after defining sexuality and sexual health, they explore why any discussion of disability and sexuality must encompass intimate relationships and sexual pleasure and not be limited to sexual dysfunction. They then highlight some of the issues, grouped around themes of: the awareness of professionals working with disabled people; improving the comfort, knowledge and skills of those professionals; and developing service policies. These are drawn together with the introduction of a new model of sexual health practice: the Recognition Model. The aim of this model is to develop competence and confidence enabling services to work in sexually affirming ways. This approach promotes positive sexual self-esteem and identifies those service users who would like help where disability impacts on intimacy and sexual health. Finally sexual surrogacy is briefly considered. Surrogacy could be a valuable resource for some disabled people but it is not formally available in the UK. Therefore the legal framework around the use of sex workers’ services is discussed.