Simply put, the sexuality of persons with mental disabilities is one of the most threatening issues confronting clinicians, line workers, administrators, advocates, and attorneys who are involved in mental health care related work, as well as the families of individuals with mental disabilities. It is “a public policy question as controversial as they get,” since the taboos and stigmas ordinarily associated with sexual behavior are inevitably enhanced when juxtaposed with stereotypes about mental disability. The subject challenges the traditional liberal position on questions of institutionalization and civil rights enforcement. It forces us to consider the extent to which rules that appear intended to protect individuals with mental disabilities by limiting or subordinating their sexual autonomy are actually the product of a patronizing paternalism toward persons with mental disabilities in institutions. The discomfort with which many respond to this subject itself reflects the massive use of ego defenses, including denial, in the way most of us think about mental disability and hospitalization.  Ultimately, our response to these issues serves as a Rorschach test for the degree to which we are willing to punish people, by restricting their ability to exercise civil rights, because they suffer from mental illness.