Comprehensive sexuality education (CSE) inclusive of cultural values and viewpoints is vital for promoting healthy sexual behaviour among adolescents. Although culture forms a huge part of the adolescent’s external environment and influences sexual behaviour, it is not always clear how culture has been conceptualised and integrated into CSE. We conducted a document review and interviews in nine selected schools in Kitwe district, Zambia. In-depth interviews (50) and two focus groups took place with 64 purposefully selected participants including pupils (35), parents (4), teachers (17), policymakers (4) and religious leaders (4). Data collection continued until saturation. Thematic analysis was employed to analyse the data. The findings revealed six main themes: the relevance of culturally appropriate CSE; lack of cultural diversity; the breakdown of traditional and social fabrics; imported CSE Western content; lack of participatory and learner-centred approaches to CSE; and age-inappropriate CSE. Analysis of the Zambian CSE framework revealed no evidence of culture being conceptualised and incorporated into the CSE curriculum. There is a need to ensure that CSE programmes are adapted to the cultural contexts in which they are applied. Engagement with the local community may be helpful in this respect.