Youths in Bolgatanga municipality in the Upper East Region in the rural north of Ghana suffer health and social problems that are caused by their premarital and unsafe sexual behaviour. This study provides more knowledge of and insight into the youths' conceptions, motives and practices concerning premarital sex in the specific cultural and social context of Bolgatanga municipality. The results of this study can contribute to the development of more effective sexual and reproductive health (SRH) programmes. Interviews with 33 youths and 27 key respondents were carried out. Four repertoires were constructed to present the dynamics wherein the youths' premarital sexual behaviour takes place. The dominant ideology of abstaining from premarital sex contrasts with the counter ideology of allowing premarital sex, influenced by increasing modernization. SRH programmes should take into account the increasing influence of modernity, gender differences and the compelling influence of peer groups, all of which contribute to youths engaging in premarital sex, with health and social problems as possible consequences.