Background: Sexuality education teachers' perspectives are important to gain a full understanding of the issues surrounding teaching this subject. This study uses a statewide sample of public school teachers to examine what sexuality education content is taught, what barriers teachers face, and which barriers are associated with teaching specific topics. Methods: Participants included 368 middle and high school teachers with sexuality education assignments in Minnesota. Survey data included topics they teach, what they think they "should" teach, and barriers they face. Logistic regression was used to examine associations between barriers and teaching each of 9 sexual health topics, among those who believed the topic should be taught. Results: Almost two thirds of participants faced structural barriers; 45% were concerned about parent, student, or administrator response; and one quarter reported restrictive policies. Structural barriers were inversely associated with teaching about communication (OR = 0.20), teen parenting (OR = 0.34), and abortion (OR = 0.32); concerns about responses were associated only with teaching about sexual violence (OR = 0.42); and restrictive policies were inversely associated with teaching about abortion (OR = 0.23) and sexual orientation (OR = 0.47). Conclusions: Addressing teachers' barriers requires a multipronged approach, including curriculum development and evaluation, training, and reframing the policy debate to support a wider range of sexuality education topics. (Contains 4 tables and 1 figure.)