Sex education is the cornerstone on which most HIV/AIDS prevention programmes rest and since the adoption of Outcomes-Based Education (OBE), has become a compulsory part of the South African school curriculum through the Life Orientation learning area. However, while much focus has been on providing young people with accurate and frank information about safe sex, this paper questions whether school-based programmes sufficiently support the needs of young people. This paper is based on a desk-review of the literature on sex and sexuality education and examines it in relation to the South African educational context and policies. It poses three questions: (a) what do youth need from sexuality education? (b) Is school an appropriate environment for sex education? (c) If so, what can be said about the content of sex education as well as pedagogy surrounding it? Through reviewing the literature this paper critically engages with education on sex and sexuality in South Africa and will argue that in order to effectively meet the needs of youth, the content of sexual health programmes needs to span the whole spectrum of discourses, from disease to desire. Within this spectrum, youth should be constructed as "knowers" as opposed to innocent in relation to sex. How youth are taught as well as how their own knowledge and experience is positioned in the classroom is as important as content in ensuring that youth avoid negative sexual health outcomes.