Sexual health is gaining more and more attention from public health practitioners and health service providers because of its contribution towards overall health and well-being in both adults and adolescents. Health risks arising from unsafe sexual practices and sexuality-related human rights abuses such as sexual coercion together contribute to the global burden of disease. Both research and consultations over the last decades have identified sexuality-related communication as an issue that requires urgent attention. While clients would like their health-care providers to discuss sexual health concerns, health workers lack the necessary training and knowledge to feel comfortable addressing such issues. There is a lack of clarity in the field as to the role of sexuality communication in primary care. In 2008 the World Health Organization (WHO) commissioned a set of case studies on the integration of sexuality counselling into sexual and reproductive health services to serve as background to the development of this guideline. In 2010 an expert consultation convened by WHO’s Department of Reproductive Health and Research (RHR) recommended the development of a guideline to facilitate the integration of this counselling into primary care services. A Guideline Development Group (GDG) was established in June 2012 comprising members working on sexual health in low- and middle-income countries, from all WHO regions and with equal gender representation. The GDG included academics, psychologists, doctors, public health specialists, lawyers and social scientists, all with expertise in developing programmes or offering clinical services to promote sexual health and well-being. It also included representatives of key constituencies with overlapping sexual health and rights expertise. Under the guidance of the GDG, a systematic review was undertaken and evidence from it was assessed by an independent researcher and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodologist using the GRADE framework. The GDG developed one good practice recommendation and two policy recommendations drawing on the expertise of the group and peer reviewers, the systematic review and insights from the Guideline Review Committee. As this is an under-researched field, the recommendations in this guideline document provide health policy-makers and decision-makers in health professional training institutions with advice on the rationale for health-care providers’ use of counselling skills to address sexual health concerns in a primary health care setting. Subsequent to the development of this guideline document on brief sexuality-related communication (BSC), WHO will develop and test specific techniques of BSC to guide health-care providers in improving the quality of their care. These will be published as a technical guideline.