Arch Womens Ment Health (2004) 7:111–121 DOI 10.1007/s00737-003-0039-z Review article Gender differences in the prevalence of childhood sexual abuse and in the development of pediatric PTSD J. L. Walker, P. D. Carey, N. Mohr, D. J. Stein, and S. Seedat MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa Received October 30, 2002; accepted November 12, 2003 Published online January 8, 2004 # Springer-Verlag 2004 Summary Despite an extensive literature on the links between childhood sexual abuse (CSA) and posttraumatic stress disorder (PTSD), our knowledge on the effects of gender in relation to the risks for sexual victimization and subsequent PTSD is limited. We review current knowledge of gender differences in prevalence of CSA and the role of gender in subsequent development of child and adolescent PTSD with specific attention to rates, phenomenology, biological correlates, and risk factors. Despite the heavy bias toward female representation in studies, the literature supports increased rates of CSA and heightened vul- nerability to PTSD in girls, as well as possible gender differences in the biological correlates and psychiatric sequelae of CSA. Further work is needed to explore the mechanisms that underlie these differences. Keywords: Sexual abuse; gender differences; posttraumatic stress disorder; PTSD. Introduction Childhood sexual abuse (CSA) is alarmingly prevalent in both female and male children and adolescents. An extensive literature and numerous reviews have advanced our understanding of this complex field (Beitchman et al., 1991, 1992; Bremner, 2003; Finkelhor, 1990). However, relatively little attention has focused on the impact of gender on the prevalence of CSA and on its psychiatric sequelae, including post- traumatic stress disorder (PTSD). This may partly reflect the fact that the majority of existing research has focused on sexually abused girls and women. Drawing together the literature that addresses the role of gender in these areas would seem justified. Several reasons have been cited for the emphasis in the literature on CSA in girls: first, boys are less likely to disclose their abuse (Browne and Finkelhor, 1986; Finkelhor et al., 1990; Knopp, 1986); second, boys are more likely to be discrepant (rather than consistent) reporters of sexual abuse (Lipschitz et al., 1999); third, the severity of abuse of boys is often underestimated; fourth, there is an assumption that boys are less adversely affected than girls (Garnefski and Diekstra, 1997); and fifth, boys may interpret sexually abusive behaviours as not abusive due to various socialisation processes (Widom and Morris, 1997). Nevertheless, there is growing recognition of CSA in boys (Beitchman et al., 1991, 1992; Friedrich, 1988) and its long term effects (Kendall-Tacket et al., 1993). This review discusses some of the problems within CSA research with respect to definition and methodol- ogy and then reviews gender differences in the preva- lence of sexual abuse, and rates, phenomenology, and risk for developing PTSD during childhood and adoles- cence. We conducted a MEDLINE search for studies published up until the end of 2002 using relevant key- words entered as search terms (child, childhood, adoles- cent, trauma, sexual abuse, PTSD, gender). In addition we reviewed reference lists of published articles. The review concentrates on and directly compares studies specifically assessing gender differences in CSA and the development of child and adolescent PTSD. The selected articles were all published between 1980 and 2002 in peer reviewed journals.