Research has shown that child sexual abuse (CSA) is related to suicidal behaviors in adolescence, a period in which suicide is the second leading cause of death in the U.S. Moreover, compared to other adverse childhood experiences, CSA is most consistently and strongly associated to adolescent suicidality. This highlights the urgency of assessment and treatment of survivors of CSA for suicide prevention. Not all survivors of CSA develop suicidality in adolescence. Knowing the risk and protective factors can help clinicians better assess the likelihood of suicidality after CSA exposure. Common risk factors include CSA by an immediate family member, being older when CSA occurred, disruption of family environment, harmful caregiver reactions, having a mental health diagnosis, higher levels of impulsivity, and contact abuse. There is less research on protective factors than risk factors. Nonetheless, studies have shown that family support and connectedness are strong protective factors. Other protective factors include active coping, social attachment, external attribution of blame, etc. Additionally, understanding pathways from CSA exposure to suicidality is paramount for treatment. Preliminary research points to self-blame, shame, and avoidance coping as potential mechanisms. Thus, focusing on shifting the pathways can be helpful in reducing suicidality, in addition to addressing risk and protective factors and utilizing general suicide prevention protocols. This chapter will explore the relationship between CSA and adolescent suicidality, risk and protective factors, and provide treatment recommendations for suicide prevention.