Background: Sexual dysfunction is a prevalent and distressing side effect of colorectal cancer treatment, particularly among early-onset colorectal cancer (EOCRC) patients. However, discussions around sexual health are often neglected, especially for women. This study aimed to investigate patterns of sexual health communication and to identify perceived barriers from both patient and provider perspectives. Methods: A retrospective survey was conducted involving 113 EOCRC survivors and 64 healthcare providers (surgeons, trainees, and nurse specialists) in Aotearoa New Zealand. Questionnaires assessed recall of sexual health discussions, perceived adequacy of information, communication preferences, and perceived barriers to raising sexual health concerns. Results: Only 30.3% of patients recalled receiving adequate information about sexual health impacts during treatment, and 21.6% during follow-up. Women were significantly less likely than men to report receiving information (p<0.001). Most patients preferred that healthcare providers initiate discussions, yet only 22.2% and 12.5% of providers reported routinely doing so during treatment and follow-up, respectively. Consultant surgeons were more likely to raise the topic than trainees (p<0.001). Key barriers included time constraints, concerns about offending patients, and the presence of family. Patients indicated a preference for receiving information via multiple modalities. Conclusions: Communication about sexual health in EOCRC care is inconsistent and frequently inadequate, particularly for women. Patients report a preference for clinicians to initiate discussions about sexual health, yet many providers cite limited confidence, training, or time as barriers. Enhanced clinician education, routine inclusion of sexual health in consultations, provision of both verbal and written information, use of pre-appointment questionnaires, and routinely asking family members to step out at the conclusion of consultations represent pragmatic, low-cost strategies to improve sexual health communication