Purpose: This paper seeks to examine the way sex and relationships education programs, as part of Health Education extra curriculum activities, have been implemented in the Greek primary schools. Design/methodology/approach: The paper presents and discusses data from an anonymous survey research questionnaire distributed to the 68 Elementary sector Health Education Coordinators throughout Greece (received responses n = 34). Findings: Findings indicate that there is an uneven distribution on teachers' choices when selecting a thematic unit for implementing Health Education projects. It has been found that Nutrition is by far the most popular topic for project development and implementation. In contrast, Sex and Relationships Education is by far the least popular, occupying only 1.6 per cent of the share of programs. Obstructive factors for Sex and Relationships Education implementation are related to the Greek educational system as well as pragmatic and moral reasons on the teachers' part. Research limitations/implications: A response rate of the survey of only 50 per cent is a limiting factor. Practical implications: On the basis of these data, teachers' awareness and training, as well as material development, are important for Sex and Relationships Education programs to become an active innovation. The role of the central administration is emphasized as well. Originality/value: The paper raises an awareness of the issue of an unsuccessful implementation of Sex and Relationships Education programs in Greece, in the light of a range of sexual health-related problems that affect the population. (Contains 3 tables, 2 figures and 3 notes.)