Childhood Trauma, Gender, and Sexual Health: Why Do Sexual Consequences Differ Between Men and Women?

Childhood trauma is linked to compromised adult sexual health, yet the field has struggled to explain why its sexual consequences appear to diverge between men and women. This narrative review addresses that question through structured searches of PubMed/MEDLINE, PsycINFO, and Web of Science, supplemented by Google Scholar and hand-searching of retrieved reviews, combining terms for childhood sexual abuse, maltreatment, sexual dysfunction, sexual risk behavior, revictimization, and gendered mechanistic constructs including emotion regulation, dissociation, attachment, and HPA-axis function, with an upper date bound of June 2026. Studies were included if they reported quantitative associations or theoretically grounded mechanisms linking childhood trauma to adult or adolescent sexual-health outcomes, or established baseline sexual-dysfunction prevalence needed to interpret trauma-exposed samples; case reports and non-English sources were excluded. Sixty-five sources meeting these criteria, spanning meta-analyses, prospective cohort studies, mechanistic neurobiological research, and foundational attachment theory, were synthesized. Findings show that childhood trauma predicts compromised sexual health in both sexes, but the pattern diverges: women show more consistent sexual dysfunction, aversion, and internalizing pathways to risk, with well-characterized revictimization trajectories, while men show inconsistently detected dysfunction, stronger externalizing and risk-taking elevations, and disproportionately higher pregnancy involvement relative to non-abused peers. Shared neurobiological embedding appears filtered through gendered emotion-regulation, attachment, and sociocultural pathways, though male survivors remain understudied and untested interventions limit clinical translation. The review further finds that every synthesized study operationalizes gender as binary, leaving transgender, nonbinary, sexual-minority, and non-Western survivors absent from the evidence base, a gap requiring urgent research and clinical attention.