Posttraumatic stress disorder (PTSD) affects approximately 69% of adults with child sexual abuse (CSA) experiences. Although the Ehlers and Clark model of PTSD (2000) explains the symptom maintenance cycle in this condition, it is unclear why male CSA survivors are less likely to disclose and seek help. This study proposed incorporating additional perspectives into the cognitive model of PTSD: gender role perceptions as impacting on negative cognitions and disclosure ability as a manifestation of avoidance. One hundred and fifty CSA survivors took part in an online study, which consisted of validated questionnaires and open-ended questions. Statistical regression and mediation models examined the associations between negative cognitions, disclosure ability, gender perceptions, and PTSD symptoms. Thematic analysis was used to identify themes within disclosure and CSA’s impact on gender role perceptions. Posttraumatic cognitions accounted for most of the variance in PTSD scores. Undifferentiation was associated with PTSD scores via more posttraumatic cognitions; androgyny was associated with fewer negative cognitions about the self and the world. Four key themes in participant disclosure experiences and CSA’s impact on gender role perceptions were identified. Clinical implications for therapeutic work with male and female survivors were discussed.