Background <p>Comprehensive Sexuality Education (CSE) provides adolescents with the necessary information and skills to make informed decisions about their sexual and reproductive health. This study was designed to evaluate high school teachers’ attitudes and explore their views regarding topics included in CSE in selected rural clusters of Mangalore, South India.</p> Methods <p>A cross-sectional study was conducted from August to November 2019 among 86 high school teachers in rural Mangalore using a validated, semi-structured questionnaire. The survey assessed attitudes towards topic-specific and general components of CSE. This was done using a 5-point Likert scale along with data on demographics and training. Statistical analysis included descriptive statistics and chi-square tests between demographic variables and attitudes using SPSS v 29.0.</p> Results <p>72% of the high school teachers agreed that it is important to provide students with accurate knowledge about sexual and reproductive health. They expressed diverse opinions on their comfort level and eagerness to discuss sensitive subjects. About 64% of teachers felt uneasy talking about subjects like sexual orientation and contraception, while 58% were not willing to talk about topics like gender identity. Teachers who had received additional health education-related professional development were significantly more likely to support comprehensive CSE material (<i>p</i> &lt; 0.05).</p> Conclusions <p>This study highlights the impact of traditional values on teachers’ attitudes towards CSE in rural areas, emphasizing the need for professional development to bridge cultural sensitivities and improve comprehensive, culturally appropriate sex education.</p>