The present review examines the published literature that is relevant to developing an understanding of the relationship between the concepts of sexual sadism and fantasy. Relevant articles were identified through searches of multiple databases. The concepts of sadism and fantasy are initially considered separately and a brief overview of the literature relating to their definition and prevalence is presented. Early influential models and studies into the role of fantasy in sadism are then reviewed. Despite their methodological limitations they continue to dominate the research in this area. More recent empirical studies arising from this early research are then critically appraised and it appears these studies have done little to advance the existing evidence base. Finally, l!lore recent and promising theoretical developments are summarised. The review concludes by questioning the proposed central role of trauma in the development of sadistic fantasies. Further research is suggested to examine alternative pathways to the development of sadistic fantasies and to investigate the moderating effects of concepts such as empathy using more diverse populations and methodology.