The present study examined the association between child sexual abuse (CSA) and a range of positive and negative aspects of women's sexual well-being. We also investigated the extent to which women's cognitive-affective sexual appraisals mediated these relationships. Participants were 272 female community college and university students. CSA involving fondling only was generally not associated with adverse sexual outcomes. However, the women who had experienced CSA involving sexual penetration or attempted sexual penetration were (a) more likely to be sexually revictimized in adulthood; (b) more likely to have engaged in casual sex, unprotected sex, and voluntary sexual abstinence; and (c) reported fewer sexual rewards, more sexual costs, and lower sexual self-esteem. These findings held over and above the effects of nonsexual abuse in childhood, and as predicted, sexual self-esteem partially or fully mediated most of these relationships. Nonsexual abuse in childhood and adult sexual victimization were also uniquely associated with a number of adverse sexual outcomes. However, outcomes were not worse for women who had experienced CSA involving actual or attempted sexual penetration and sexual assault in adulthood. The results highlight the fact that CSA is a serious and widespread problem with significant implications for adult women's sexual functioning.