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Sexual health education should meet the needs of all students. One strategy educators can use to ensure instruction meets students' needs is to encourage the submission of anonymous questions, allowing students to gain information without fear of instructor or peer reactions. We investigated anonymous questions submitted by middle school (7th-grade, ages 12-13) students during a sexual health education curriculum in Ohio, USA. Questions (n=893) were organised into 12 categories: reproductive anatomy (n=186), LGBTQ+ topics (n=130), sexual behaviour (n=120), class-related questions (n=99), pregnancy (n=78), slang (n=52), STIs (n=44), protection/birth control (n=33), relationships (n=19), consent (n=14), health services (n=9), abstinence (n=1), and unrelated questions/comments (n=108). After categorising questions, we conducted thematic analysis with the three largest categories (reproductive anatomy, LGBTQ+ topics, sexual behaviour). Results revealed students wanted to know about the normality of the processes and functions of their bodies. Students also expressed concern and had internalised social norms about LGBTQ+ topics. Student questions about sexual behaviour suggested they wanted to learn more about the purposes and processes of sex, e.g., how people have intercourse. Findings underscore the need for inclusive, comprehensive and medically accurate sexual health education for early adolescents. We discuss implications for student health/well-being, educator development, and school staff. [ABSTRACT FROM AUTHOR]