The current study explores the unique impacts of female-perpetrated child sexual abuse (CSA) on male forensic patients. This research addresses various gendered stereotypes regarding sexual violence, particularly when committed by females against males. Utilizing data from 2,734 men assessed at the Royal Ottawa’s Sexual Behaviours Clinic between 1982 and 2024, the study explores how factors such as perpetrator gender, nature of abuse, and victim perpetrator relationship may influence victims’ sexual interests, perceptions of abuse, substance use, and physiological responses within penile plethysmography. Key findings suggest that female-perpetrated CSA may be underreported due to societal scripts that minimize the impact of female offending. Victims of female-perpetrated abuse often reported lower levels of coercion and were more likely to describe themselves as ‘willing participants’, highlighting how gendered expectations of masculinity may have an affect abuse reporting. The study also revealed that victims of female abuse tend to develop unique psychological and behavioural patterns, including higher rates of biastophilic and sadistic sexual interests. The results underscore the importance of expanding clinical approaches to encompass the complexities of female-perpetrated CSA, which has traditionally been overlooked in research. These findings contribute to a growing body of literature advocating for nuanced interventions for male victims of sexual violence, irrespective of the gender of the perpetrator.