Concepts of choice are often drawn upon within sexual health promotion discourses to encourage young people to take “responsibility” for and promote their own sexual health and reproductive control. A systematic literature search using predefined inclusion criteria identified peer-reviewed articles focusing on sexual health interventions for young people. Discourse analysis was used to interrogate how concepts of choice were articulated or inferred within the interventions. Of the eligible studies (n = 30), 16 were based on theories of behavioral change, suggesting a linear pathway between choice and improvements in sexual health. Studies that accounted for contextual factors were a minority (n = 6). Overall, study reports offered a limited account of the “situatedness” of young people’s opportunities to exercise choice. This reliance had a tendency to position young people as passive recipients of interventions which seemed to undermine the more active notion of “making choices” presented within these frameworks.