Sexual and fertility education for pediatric patients requires a nuanced and developmentally tailored approach that can address a broad spectrum of different health conditions. Discussing sexual topics is often challenging due to cultural, developmental, and family dynamics, necessitating an open and inclusive communication strategy. The basis of any educated discussion centers around describing anatomically correct terminology and proper nomenclature from early childhood. Key developmental milestones include understanding body autonomy, consent, and the progression of puberty, with anticipatory guidance for children with conditions impacting sexual function. These conditions include exstrophy-epispadias complex, spina bifida, hypospadias, gender dysphoria, and patients with differences of sexual development. Furthermore, cryptorchidism, testicular torsion, varicocele, hypospadias, and cloacal malformations all have implications for future fertility and sexual function. Patients benefit from individualized, affirming education, with fertility preservation counseling when appropriate. Teaching sexual and reproductive health should address unique anatomical, functional, and psychosocial challenges to ensure patients develop healthy sexual relationships and a greater understanding of their fertility potential.