The purpose of this study was to understand how young Appalachian mothers retrospectively construct sexual and reproductive health communication events. Sixteen in-depth qualitative interviews were conducted with mothers between the ages of 18 and 22 from the South Central Appalachian region of the USA. Findings indicate that within this population, peer influence, stereotypes medical encounters and formal health education are experienced within a culture that exhibits tension between normalising and disparaging adolescent sexuality. Theoretical and applied implications acknowledge the role of Appalachian cultural values, including egalitarianism, traditional gender roles and fatalism, in understanding the social construction of young people's sexuality in this region. Practical implications for sexual education and the nature of communication in the healthcare setting can be applied to current education curricula and medical communication practices. We suggest that future programmes may be more effective if they are adapted to the specific culture within which they are taught.