The novel's explicit reference to the sexual reproduction of dogs and the innocent, straightforward discussion that follows may concern some readers or their parents. Those who support some degree of censorship may not like the overtly anti-censorship stance of the book or the negative portrayal of censors. Clearly, the anti-censorship characters are the heroes of this work.

Another sensitive aspect of Maudie and Me and the Dirty Book is eleven-year-old Kate's apprehension about middle school. She tries very hard to be "cool" and to choose the right friends. The slightly overweight Maudie is at first shunned by Kate and the rest of the students. After getting to know Maudie, Kate sees her only as a good and trusted friend.