Accessible summary Some men with learning disabilities have a sexual fetish which may present a support challenge for staff or carers.Sexual fetish in people with learning disabilities is often ignored, seen as pathological or associated with risk.It is possible to support sexual fetish in person‐centred ways which respect individual rights and informed choice. SummaryThis paper reports on a psycho‐educational intervention associated with the sexual fetish of a man with mild learning disability and autism which centred on his use of nappies and baby paraphernalia. It outlines the nature and expression of his sexual fetish and the risks perceived to be associated with it and describes the approach developed to support him, including the aims which underpinned the work and the methods and processes employed. It was found that a person‐centred psycho‐educational approach from a rights based perspective achieved important changes in his life and self‐esteem and helped challenge assumptions about his sexual risk. The paper also reflects on the organisational location of this work and identifies the applied learning for supporting the sexual fetish of people with learning disabilities, of value for informing sex education and sexuality support for people with learning disabilities more widely.