Young people aged 10–24 years represent one-third of the Ghanaian population. Many are sexually active and are at considerable risk of negative health outcomes due to inadequate sexual and reproductive health knowledge. Although growing international evidence suggests that parent–child sexual communication has positive influence on young people’s sexual behaviours, this subject has been poorly studied among Ghanaian families. This study explored the extent and patterns of parent–child sexual communication, and the topics commonly discussed by parents.

A cross-sectional design was used to sample 790 parent–child dyads through a two-stage cluster sampling technique with probability proportional to size. Interviewer-administered questionnaire method was used to gather quantitative data on parent–child communication about sex. Twenty sexual topics were investigated to describe the patterns and frequency of communication. The Pearson’s chi-square and z-test for two-sample proportions were used to assess sexual communication differences between parents and young people. Qualitative data were used to flesh-out relevant issues which standard questionnaire could not cover satisfactorily.

About 82.3% of parents had at some point in time discussed sexual and reproductive health issues with their children; nonetheless, the discussions centered on a few topics. Whereas child-report indicated that 78.8% of mothers had discussed sexual communication with their children, 53.5% of fathers had done so. Parental discussions on the 20 sexual topics ranged from 5.2%-73.6%. Conversely, young people’s report indicates that mother-discussed topics ranged between 1.9%-69.5%, while father-discussed topics ranged from 0.4% to 46.0%. Sexual abstinence was the most frequently discussed topic (73.6%), followed by menstruation 63.3% and HIV/AIDS 61.5%; while condom (5.2%) and other contraceptive use (9.3%) were hardly discussed. The most common trigger of communication cited by parent–child dyads was parent’s own initiation (59.1% vs. 62.6% p = 0.22).

Parents in the Brong Ahafo region of Ghana do talk to children about sex, but their conversations cover limited topics. While abstinence is the most widely discussed sexual topic, condoms and contraception were rarely discussed. Sex educational programmes ought to encourage parents to expand sexual communication to cover more topics.