OBJECTIVE: To compare the knowledge, attitude and practice of boys and girls on reproductive sexual health and their perspective on the needs of adolescents on this aspect. METHODS: This comparative study was conducted among boys and girls between 10 and 24 y in three districts of Kerala; through a cross sectional community survey using a pretested structured schedule with additional sexuality related questions for 15-24 y age group. RESULTS: Higher percentage of boys knew about condoms (95.1%, p 0.001) whereas higher percentage of girls (56.5%, p 0.001) knew about copper-T. Girls had a better knowledge on legal age of marriage (91%, p 0.001), that both the partners are equally responsible for the problem of infertility (89.7%, p 0.009) and that the gender of the baby is determined by male sperm (60.4%, p 0.001). Above 90% of boys and girls demanded adolescent care services and facilities for counseling. CONCLUSIONS: This comparative study on knowledge, attitude and practice of boys and girls between 10 and 24 y has shown that greater proportion of girls had correct knowledge on the legal age of marriage, ideal age of pregnancy, preferred an arranged marriage and felt the need for premarital counseling.