This study elicited views of key stakeholders on the need for adolescent sex education and the appropriate model to adopt in Saudi Arabia. Semi-structured interviews were conducted in Riyadh, Saudi Arabia, with 28 stakeholders: policy-makers; social and healthcare providers; teachers and school staff; and religious scholars. Interviews were recorded and transcribed verbatim. Thematic analysis was conducted to identify emerging themes. Stakeholders saw the need to provide sex education. Opinions fell across a spectrum of model preference: abstinence-only or harm reduction. The conceptualisation of harm incorporated social risks. Silences and avoidance marked the boundaries between what was permitted and what was prohibited. In determining the form of any sex education curriculum in Saudi Arabia, caution is needed in assuming the ready transferability of Western-based models of sex education since in Saudi Arabia harm is conceptualised as damaging personal reputation, social structure and physical health. Religious doctrine and scientific evidence are perceived as non-conflicting sources for formulating a culturally sensitive programme. Local idiom characterised by indirectness and ambiguity offers challenges and possibilities for conveying sensitive messages. Findings from this study can be useful for communities with similar religious beliefs or social traditions intending to formulate an acceptable sex education programme.