School nurses play a vital role in the promotion of sexual health. However, there is very limited evidence of how school nurses experience this topic in an Islamic cultural setting. Using an exploratory qualitative design, 13 in-depth interviews were conducted with Egyptian school nurses. Data were subject to thematic analysis. Four themes emerged from this analysis, "personal issues," "cultural and political dimensions," "parental issues," and "skills and confidence." These themes represented how nurses' views on sex education were tempered by personal and social forces--affecting their practice. Fear of being blamed for creating a permissive culture was a feature of nurses' concerns in this culture. The belief that sex education is morally challenging affected nurses and must be addressed to enable effective sex education to take place. School nurses must contribute actively to this debate and receive governmental support.