Despite considerable efforts, progress in the implementation of sexuality education (SE) has been uneven. This study identified six “positive-deviant” low- and middle-income countries, i.e., countries that had scaled up, sustained and enhanced their SE programs when many others—in similar social, cultural and economic circumstances—were not able to do so. In other words, they were significantly and consistently more successful than the norm. Countries were shortlisted using a validated framework and were analyzed using three other validated frameworks on political priority setting, scaling up, and stakeholder engagement. The study found that India, Pakistan, Nigeria, Senegal, Mexico, and Uruguay had scaled up (either nationwide or in some states/provinces), sustained and enhanced their SE programs in very different contexts. In all six, SE was a political priority, the national or state/province level SE scale up effort had been carefully planned and managed, and a mix of methods were used to build support and/or to overcome resistance. The study points to what needs to be done better/more energetically/differently in research, program support-tool development, and policy and program support to change the status quo.