Purpose: The purpose of this paper is to examine how school-based sexuality education has had a long and troubled history of exclusionary pedagogical practices that have negatively affected such populations as lesbian, gay, bisexual, trans, queer (LGBTQ) individuals, people of color, and the disabled. The social ecological model is introduced as a way of offering sexuality educators and school administrators a way of thinking more broadly about how to achieve sexual health through sexuality education efforts inside and outside of the school environment. Design/methodology/approach This paper uses critical analysis of current and historical school-based sexuality education methods and curricula used in the USA. Authors use both academic journals and their own expertise/experience teaching sexuality education in the USA to analyze and critique the sources of sexuality education information and curricula used in schools. Findings: Historically, sexuality education in school settings in the USA has been biased and has generally not offered an educational experience fostering sexual health for all students. There are now welcome signs of reform and movement toward a more inclusive and progressive approach, but there is still some way to go. Sexuality education programs in schools need to be further and fundamentally reformed to do more to foster sexual health particularly for LGBTQ individuals, students of color, and people with disabilities. Practical implications: This paper offers sexuality educators ways of addressing structural issues within the sexuality education curriculum to better serve all students to increase the quality of their sexual health. Integrating critical pedagogy and anti-oppressive education can increase students' sexual health along physical, social, emotional, intellectual, and spiritual dimensions. Originality/value: This paper provides historical analysis along with the identification of structural difficulties in the sexuality education curriculum and proposes both critical pedagogy and anti-oppressive education as ways of addressing sex and relationships education.