Research shows that many adult sexual behaviors may be related to childhood sexual abuse (CSA), ranging from withdrawal and dysfunction on one end of the spectrum to hypersexuality and compulsion on the other, but it is unclear why some individuals respond to CSA by withdrawal, fear and anxiety, while others respond with impulsiveness and acting-out behavior. This literature review finds that there are two distinct factors which account for differences in sexual behavior among adult survivors of CSA: (a) the gender of the victim, and (b) the age at onset of victimization. Based on this data, an integrative framework is proposed, incorporating elements of social learning theory and psychoanalytic concepts, to explain the etiology of problematic adult sexual behaviors, as well as corresponding implications for clinical treatment. Abstract published by arrangement with Taylor and Francis.