We review the evidence base for men who categorically deny responsibility for their sexual crimes. Specifically, we grapple with the ambiguities in definition and conceptualisation, review the context and function of denial, the impact on identity and self-presentation, and explore the evolutionary basis for denial. The review considers denial’s relationship with risk and the implications for intervention. We outline the possible strategies for working with those who deny their offending and are critical of disclosure-based approaches. We suggest that some of the most promising approaches are based on working with the individual, their needs and on reducing shame and stigma. We can work with those denying their actions, but our approaches require us to move away, using denial as an organising principle of intervention.