The aim of the meta-synthesis was to determine any difficulties experienced by caregivers relating to the sexuality of people with intellectual disabilities and how they address those difficulties. A qualitative meta-synthesis was used to integrate the findings from 17 papers about these topics. The synthesis produced five concepts: ‘Fear and Uncertainty’, ‘Impact of Perceptions of Sexuality’, ‘The Same and Different’, ‘Balancing the Roles of Protector and Facilitator’ and ‘Conditional Sexuality: Conditional Support’. The findings suggest key issues for caregivers in relation to addressing the sexual needs of people with intellectual disabilities and highlight the possible implications of caregivers own views on their practice. These issues are discussed and in conclusion the review offers explanations about what the difficulties for caregivers are and how they might be addressed, as well as recommendations for future research.