Clinical sexual health consultations with young women often focus on avoiding ‘risks;’ namely pregnancy and sexually transmitted infection transmission. They also typically fail to explore how contraception use can impact on the capacity to enjoy sexual relationships. In contrast, this paper argues that sexual pleasure should be a starting point for all sexual health consultations and education work with young people. Drawing on our experiences of working for a UK sexual health charity for young people we suggest that excluding pleasure from sexual health consultations creates its own risks. A pleasure deficit model not only detracts from a full and frank exploration of sexuality, which is bound up with notions of sexual subjectivity and agential practices, but can also limit concerns regarding the adverse effects of contraception such as loss of libido. Using the example of long acting reversible contraception we note there is a tendency to privilege adult/‘expert’ advice over young women’s bodily knowledge. We also indicate how silence and discomfort regarding sexual pleasure may confound contraceptive consultations, for example in the case of emergency hormonal contraception provision. Establishing sexual pleasure as a starting point will provide a broader, positive and less risky focus on sexuality and sexual health.