Comprehensive sex education (CSE) is evidence-based, addresses a wide variety of topics, and is inclusive of sexual and gender minority (SGM) experiences. However, teachers are often not trained to deliver CSE and are uncomfortable teaching it. This can lead to the omission of important topics and leave youth dissatisfied with their sex education. Thus, more research is needed to understand educator needs/approaches when delivering sex education and how educators incorporate SGM-affirming content. We conducted fifteen interviews with sex educators in Metro Vancouver, British Columbia (BC), Canada, in autumn 2021, to understand current approaches to and gaps in the provision of CSE. We used an interpretive descriptive methodology. Personal and structural factors constrain the delivery of CSE in BC. Personal factors include motivation, teacher comfort/knowledge, personal trauma, and fear of pushback. Structural factors include inequitable access to parent advisory council funding, Learning Standards design, and the peripheral nature of sex education. Participant recommendations for the future of sex education include increased mandatory pre-service and in-service training, the implementation of “sex education mentors” in each district, an online hub of resources, and government funding for community-based educators. We recommend (1) that government funding be allocated for at least one trained sex educator in every school district who can coach and mentor teachers; (2) the creation and promotion of an online information hub which includes lesson plans, videos, and resources for teachers; (3) and that teachers’ colleges create mandatory courses on teaching CSE.