Childhood sexual abuse (CSA) is a prevalent problem that can have a devastating impact across the lifespan on the mental and physical health, interpersonal relationships, and myriad other aspects of the lives of those who experience it. Therefore, it is essential for psychologists and other mental health practitioners who treat survivors of CSA to understand both the nature and the far-reaching consequences of adverse childhood sexual events on survivors. Although prior research has shown that CSA can have a significant effect on the sexual interest and functioning of adolescents and young adults, there is a dearth of research studies examining whether its impact extends into midlife and old age. This study examined the effects of CSA on the sexual interest and motivation, sexual behavior and functioning, and sexual and emotional satisfaction of men and women in midlife and old age (ages 56 and older). The research questions explored with data from the second wave of the National Social Life Health & Aging Project (NSHAP). It was found that child sexual abuse predicts higher levels of sexual activity for men in midlife and old age. The discussion focuses on the meaning of this finding and directions for future research.