The methodologies of demand-led sanitation programmes (including community-led total sanitation [CLTS] and sanitation marketing) encourage participation of users in the design of appropriate sanitation facilities. There has been limited examination of the application of established methodologies in participatory design in the sanitation sector. This paper describes and reflects upon three case studies that applied established participatory design methodologies to create sanitation technologies in rural Malawi. The paper critically reflects on the processes of participatory design in relation to power, ownership and continued participation.