University women in Uganda continue to face multiple sexual and reproductive health challenges despite ongoing efforts primarily focused on pregnancy prevention. This study aimed to broaden the understanding of sexual health among university women by examining the extent to which comprehensive sexual health skills—beyond pregnancy prevention—are addressed, understood, and practiced. Using a mixed-methods approach, the study collected quantitative data through structured questionnaires and qualitative insights through interviews and focus group discussions among female university students. The findings reveal that although awareness of pregnancy prevention methods is relatively high, knowledge and practical skills related to sexually transmitted infections, sexual consent, communication with partners, and autonomous decision-making remain limited. Social norms, gender power imbalances, stigma, and inadequate access to youth-friendly services further constrain women’s ability to practice safe and healthy sexual behaviors. The study underscores the need for a paradigm shift from narrowly defined pregnancyfocused interventions toward comprehensive sexual health education that equips university women with practical life skills. By addressing both individual competencies and structural barriers, such an approach can contribute to improved sexual health outcomes, reduced vulnerability to sexual risks, and enhanced overall well-being among university women in Uganda.