Sexual dysfunction has been associated with considerable mental health and interpersonal problems. Gay and bisexual men report a higher rate of sexual dysfunction and childhood sexual abuse (CSA) compared to heterosexual men. The relationship between CSA and adult sexual health problems has been well established; however, the pathways leading from CSA to erectile dysfunction are poorly understood. The role that coping strategies, emotion dysregulation, and substance use play in the association between CSA and erectile dysfunction was examined using a mediational model. Results were not found to be statistically significant, with the exception of a significant relationship between CSA and avoidant coping. Possible explanations for the lack of significant findings are discussed, including problems with the measurement of ED. This study provided support for the disproportionately high rates of CSA among gay men.