Nurses working in sexual health and primary care are at the forefront of providing patients with contraception and sexual health advice, and face many dilemmas. Using Johns’ (1995) reflective framework, this article examines a consultation that took place at an integrated contraception and sexual health clinic: the case was unusual and provided an opportunity to examine various aspects of sexual health. The reflection enabled the exploration of a complex consultation that covered contraception, sexuality, abstinence and potential issues such as sexual dysfunction. The scenario highlighted barriers to assessing sexual health, as well as the importance of gaining a grasp of the situation – from taking a history well to not being afraid of asking difficult questions.