Refugee youth face several sexual health challenges, and research investigating contributing factors has primarily focused on identifying contextual barriers. However, it is also important to investigate protective factors, as well as how both risk and protective factors work together across contexts. The present study explored facilitators and barriers to refugee youth sexual health and how they combine to predict behavior using thematic text analysis and narrative analysis of twelve in-depth interviews with female refugees ages 18-24. Findings revealed four primary themes: sex/relationship restrictions, judgment/disapproval, support, and youth reactions. The first three factors were present across multiple ecological levels, such as parents, peers, and culture. Furthermore, these contextual factors were related to one another, such that youth who violate sociocultural sex/relationship restrictions experience actual or anticipated judgment from others, which leads to fear, embarrassment, and risky sexual behavior. These findings have important implications for sexual health education interventions with refugee youth.