Objective: According to the World Health Organization, premarital sexuality, unplanned pregnancy, and the spread of sexually transmitted diseases are major problems in adolescent sexual health. In China, adolescents generally lack sexual health knowledge and contraceptive ability while the sexual health education has long been backward or even stagnant. This study was aimed to understand the demand of sexual health education, and explore appropriate sexual health education strategies among middle school students in China. Methods: A self-designed questionnaire was used to conduct a self-administered anonymous survey in selected six middle schools of Shanghai and Zhejiang Province, China in October 2021. Totally, 1733 students were cluster-sampled. Results: Among 1733 subjects, 69.4% had received sexual health education before, and it was significantly lower among boys (boys: 66.1% vs. girls: 73.7%, P <0.001). More than half (51.7%) were very satisfied with their received sexual health education, and it was lower among girls (girls: 47.4% vs. boys: 55.4%, P­ =0.048) and senior high school students (senior: 48.3% vs. junior: 59.7%, P =0.003). Near 2/3 of them believed that they had easy access to sexual health knowledge. Above fifth two wished to learn more about sexual health, and sexual psychology (52.8%), sexual health care (48.1%) and sexual moral law (46.7%) were ranked top 3 in what they wanted. Schools (60.2%) and teachers (51.0%) were the most welcome facility and provider respectively for them. Conclusions: There are great demands for sexual health education among middle school students, and the role of schools and teachers should be enhanced to promote their sexual health, in China.