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The realization of married women’s sexual and reproductive health rights remains a persistent global, continental, and national challenge. In South Africa, rural married women continue to face heightened vulnerability to sexually transmitted infections, including HIV, largely due to male partners’ denial of their agency in exercising these rights. This article critically examines the barriers rural married women encounter in asserting their sexual and reproductive health rights within marital unions. The article draws from a qualitative study that explored married men’s perceptions and experiences regarding their spouses’ sexual and reproductive autonomy. Despite growing discourse on gender and health rights, there remains a paucity of empirical research addressing this intersection within the context of marital relationships. Data were collected through semi-structured interviews with twenty-eight rural married men residing in the Lephalale villages of the Waterberg District in Limpopo Province. A non-probability sampling technique was employed, and data were analyzed using Tesch’s eight-step method of qualitative data analysis. Key findings revealed a significant lack of autonomy among married women, influenced by entrenched patriarchal norms. Moreover, socio-economic marginalization, religious doctrines, and cultural practices emerged as structural impediments that silence women and inhibit their ability to exercise their sexual and reproductive rights.