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The sexual abuse of male children is an under-recognized problem. There has been scant research into the long-term impact of sexual abuse upon males. Especially little is known about factors which are associated with later disturbance. A clinical sample of 124 men completed questionnaires which included several measures of psychological functioning and a sexual abuse history. The sample was characterized by a preponderance of intrafamilial abuse and multiple perpetration. The incidence of female perpetrators was much higher than found in case-report studies. The relationships among various factors associated with the abuse, psychiatric history, and current psychological functioning were assessed. Outcome measures included a symptom checklist; attributions about the benevolence of the world; a self-esteem scale; self-reports of sexual adjustment and satisfaction; and history of psychiatric hospitalization, psychotropic medication, and suicide attempts. Several factors were associated with each of the indices of negative outcome. Poor psychosocial functioning was predicted by the following factors: abuse of earlier onset, longer duration, and greater severity; abuse by a member of the immediate family, abuse by a male; multiple abusers; drug use by perpetrator; and the presence of physical abuse. The significance of substance abuse and physical abuse along with the sexual abuse leads the author to argue for a broader view of child sexual abuse, integrating other forms of family dysfunction which may co-occur. A subsample of participants were interviewed regarding the impact of their childhood sexual abuse. It was uniformly perceived as severely damaging to most aspects of their lives. Issues which appear to be of particular salience to male survivors are gender shame: a feeling of repugnance regarding men and oneself as a man; a powerful sense of dissonance, with concomitant difficulty integrating one's role expectations as a male with one's experience of victimization; doubts and confusion regarding one's sexual orientation; and fear that one will repeat the cycle of abuse. The author argues that increased attention to and acknowledgment of male victimization is the best way to decrease the incidence of male perpetration.