Aboriginal and Torres Strait Islander communities call for reproductive and sexual health services that are culturally sensitive and affirming, and embedded within cultural frameworks. Considerations include: cultural competency of healthcare practitioners; and access to culturally appropriate support. The concept of ‘shame’ can still play a part in people’s experience of sexual health and their willingness to seek support and information. The impact of intergenerational trauma, a history of control over reproductive health rights, and broader health inequities requires consideration. An understanding the local context is particular important in rural communities where services are limited, communities are closely connected and anonymity in relation to sexual health is very difficult to guarantee.