Adolescent sexual development is informed by individual, relational, generational, institutional, and cultural perspectives. Families matter: they are the social institution at the intersection of adolescent development and broader social systems, charged with the responsibility for rearing children and adolescents to adulthood. This narrative review maps insights from family theory and research onto adolescent sexual development research. Our purpose is to inform sexuality researchers from diverse fields about how family perspectives can enrich understanding of adolescent sexual development. We present the critical, intersectional theoretical framework guiding this review as consisting of three meta-themes for understanding families through an examination of family structure, process, and context. Then, we apply those meta-themes to current research on adolescent sexual development by selectively organizing our review around the contexts of family structural diversity and family relational complexity, demonstrating that both the structure and the process components are embedded within the intersectional and cultural contexts that shape and are shaped by families. Our review demonstrates that diverse, intersectional family structures and transitions may affect adolescent sexual development by influencing family processes, particularly around sexual communication. We conclude with implications of using family perspectives for future inquiry related to adolescent sexual development.