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Introduction: Good Sexual and Reproductive Health (SRH) encompasses complete physical, mental, and social well-being in all matters related to the reproductive system. Access to accurate information is crucial for maintaining SRH. Adequate knowledge and perception regarding sexual health play a vital role in reducing Sexually Transmitted Infections (STIs), teenage or unwanted pregnancies, and empowering individuals against sexual violence. Aim: To evaluate the knowledge and perception of sexual health and associated factors among college students in Perinthalmanna, Malappuram District, Kerala. Materials and Methods: A cross-sectional study was conducted among 540 students from January to April 2022 among 540 students attending MES Arts and Science College in Perinthalmanna, Malappuram District, Kerala, India. A semi-structured questionnaire was used to assess their demographic details, knowledge, and perception regarding sexual health. The Chi-square test and Independent t-test were employed, and multivariate logistic regression was performed to identify independent predictors, including the students' academic qualification, educational status of their mothers, and prior information on sexual health. Results: The respondents were predominantly male (60.4%), with a mean age of 19.32±1.262 years. The majority (95.4%) were undergraduate students, while 4.6% were postgraduate students. Muslims accounted for the majority of respondents (83%), followed by Hindus (14.6%). More than 90% of the participants were unmarried. Approximately 60% of the respondents' mothers and 51% of the fathers had a high school education. Out of 540 respondents, 487 (90.2%) reported having obtained information on sexual health. Friends (41.7%) were the most preferred sources of information. The mean score for respondents' knowledge was 3.79±1.3, and the mean score for perception was 31.26±4.5. Being a postgraduate student (p=0.035), having a higher educational status of the mother (p=0.034), and prior information on sexual health (p<0.001) were significantly associated with higher knowledge. Being a postgraduate student (p=0.02) and having a higher educational status of the mother (p=0.03) were significantly associated with higher perception. A total of 21% of the respondents stated that sex education should be provided according to age appropriateness. Gender-wise differences were observed in the respondents' opinions regarding the timing of sex education (p=0.024). Conclusion: Good knowledge and positive perception levels were significantly associated with the academic qualification of the study subjects and the educational status of their mothers. However, the respondents' knowledge regarding fertilisation, pregnancy, and contraceptives was deficient. Therefore, implementing a comprehensive sexual and reproductive health education program in schools and colleges, along with behavioural change communication materials, is urgently needed. [ABSTRACT FROM AUTHOR]