Survey and focus group discussions examining sexual health issues for young people were conducted with 1168 year 8 and year 10 secondary school students living in small rural communities across Australia. Growing up in the country was generally perceived as a positive experience; however, many young people felt that they had little privacy. Two main areas of concern emerged in relation to sexual health issues: worries about being recognised in public venues such as doctor's surgeries and chemists, and the informal mechanisms among peer groups that appraised and regulated sexual behaviour and attitudes. There were some significant gender differences evident in the expectations and experiences attached to these concerns, with girls expressing more awareness of and concern towards their public reputations when accessing sexual health services. They also felt that their sexual reputations among peers were closely monitored by way of their behaviour and appearance. This can militate against confident and assertive safer sex strategies such as condom use, when initiating or insisting upon condom use is construed as evidence of promiscuity or a preparedness to engage in sex. Concerns around privacy may be acutely experienced by young rural women, and health services providers need to be aware of these issues and efforts need to be made to address and allay the apprehensions of young people in this sensitive area.