Sexual assault is a pervasive problem on university and college campuses. Although not a new problem, media and political attention has placed renewed pressure on institutions of higher education to prevent and respond to campus sexual assault. To be effective, policies and procedures need to fit with the contextual and administrative realities of the institution. To help IHE administrators better understand and navigate the nuanced issues surrounding campus sexual assault, the following paper synthesizes the empirical literature with a focus on 6 general and 3 administrative tensions inherent to IHE sexual assault prevention and response strategies.