This article draws on grounded theory and ethnographic fieldwork approaches and applies a political ecology of adolescent health (PEAH) framework to examine how school-going adolescent girls and their communities perceive sexual and reproductive health education (SRHE) and menstrual hygiene management (MHM) in the region. Three young girls were purposefully selected from each of 10 government-run mixed primary schools in Juba, South Sudan, as peer research evaluators (PREs) and key informants (N = 30). Each PRE interviewed and reported on three of their peers about how they talk about and manage menstruation. The findings show that political, socioeconomic, and cultural factors do influence adolescent girls' and their communities' perceptions about puberty and menstruation. In general, MHM was culturally constructed, but the results show a disproportionate emphasis on social norms rather than on SRHE, which could have long-lasting health implications for adolescent girls. There is a need for all stakeholders in education to come together to better grasp and address the obstacles young girls face in their communities and school environments. There is also a need to develop relevant training materials to assist care providers and adolescent girls to openly talk about and address sexual and reproductive health issues.