Strict norms about hygiene may sometimes have health benefits but may also be a burden. Based on research in the United States, it has been suggested that women traditionally shoulder responsibility for hygiene standards and therefore tend to have stricter views on hygiene. However, there is little systematic research on sex differences in hygiene norms at the global scale. We set up two hypotheses: (1) Stricter hygiene norms among women than among men is a global phenomenon. (2) The size of this sex difference varies across nations with the level of sex equality. We examine these hypotheses using data from a recent international survey (N = 17,632). Participants in 56 countries were asked for their views of where it is not appropriate for people to spit and in which situations people should wash their hands. As a measure of sex equality, we use an existing country-level measure of attitudes to equality between the sexes, available for 49 nations in the study. Stricter hygiene norms among women than among men are observed almost everywhere, but there are a few exceptions (most notably Nigeria and Saudi Arabia). The size of the sex difference in hygiene norms varies strongly with the level of sex equality, but in a non-linear way. The sex difference is most pronounced in moderately egalitarian countries with the highest recorded difference being in Chile. In more egalitarian parts of the world, more sex equality is associated with a smaller sex difference in hygiene norms. In the less egalitarian parts of the world, the opposite relation holds. We offer an interpretation in terms of what different levels of sex equality mean for the content of sex roles.