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Objective: Women with histories of childhood sexual abuse (CSA) are at a higher risk for sexual dysfunction, and show a differential response to sex therapy, than women without abuse histories. The factors underlying those differences have yet to be clearly articulated by the literature. This study examined potential mechanisms of action to account for the relationship between CSA and sexual function. Method: Participants were 120 adult women recruited from the local community. Women completed a single laboratory session in which they viewed a short erotic film and completed a battery of questionnaires on sexual health. Data were analyzed with structural equation modeling mediation, an approach that enables comparison between groups of women. Results: Sexual shame completely mediated the relationship between history of CSA and sexual function, and explained this relationship better than any of the other candidate mechanisms. Conclusions: Several differences have been noted between the sexual function of women with and without histories of CSA. Results suggest that differences in sexual shame may contribute to differences in sexual function between these groups. For women with CSA histories treatments that aim to reduce sexual shame may improve sexual function.