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Background With the rising trend of sexual engagement among Vietnamese young adults in recent years, concerns were raised over the issue of premarital sex and its potential health consequences. In order to prevent such consequences and further promote health, an in-depth understanding of factors influencing young people to have premarital sex would be valuable. Objective To generate a grounded theory explaining factors influencing engagement in premarital sex among Vietnamese young adults. Subjects Vietnamese adults aged 18–24 who have voluntarily engaged in premarital sex (n = 18). Method The study was conducted using the grounded theory approach by Glaser. Purposive and theoretical sampling was used. Ten in-depth interviews and three additional focus group discussions were carried out. The interviews were audio-recorded and transcribed verbatim. Data analysis involved using the constant comparative method and open and theoretical coding. Sampling, data collection and data analysis happened simultaneously until theoretical saturation was achieved. Results The grounded theory is constructed around six emergent themes: (a) desire as the ‘direct cause’; (b) the facilitators; (c) social changes; (d) media; (e) peer and (f) absence of family. The latter four themes are ‘indirect causes’ that influence through desire and the facilitators. Conclusion The study has contributed a grounded theory that identified the factors and described their relationships in a comprehensive way. It suggested a need for a reliable source of information to be tailor-designed to suit young people. Additionally, the stigma of talking about sex needs to be reduced to allow for more open discussions on sex and sexual health.