Objective: To explore teachers' beliefs, experiences and barriers influencing teaching related to sexual health education. Methods, Design and Setting: Descriptive, cross-sectional study design. Rhode Island certified health teachers (n=190) completed an online sexual health education survey. Teacher perceptions about the need and benefits of teaching this subject, coverage of essential topics, their experiences and the barriers they faced were gathered. Qualitative questions were analysed using open, axial and selective coding. Constant comparative approach was used to identify themes. Descriptive statistics were used to analyse quantitative items. Results: Findings indicated that 98% of teachers felt that sexual health education should be taught. Less than 50% agreed that coverage for topics identified in the national sexuality education standards for grades K-12 should begin at each grade level. Two common themes -- prevention and access to accurate information -- emerged as reasons for teaching the subject. Themes generated from teacher experiences revealed the use of a risk reduction approach to sexual health education. Healthy sexual development, gender identity, inclusive education and all components of a comprehensive approach were not identified. Perceived barriers to teaching included teacher comfort, time, parents' likely responses and lack of training. Conclusion: Findings signal the need for ongoing professional development to broaden teachers' understanding of comprehensive sex education and address the beliefs and barriers that hinder inclusive and comprehensive teaching approaches. Good quality training in which teachers reflect on their beliefs and develop proficiency in the use of effective pedagogies can strengthen educator capacity and self-efficacy.