Sexual abuse in minors aged 6-17 years is a significant public health concern. Victims of sexual abuse are at risk of developing complex psychopathology and chronic suicidal thoughts. Posttraumatic stress disorder (PTSD) develops in one-third of minors with a history of sexual abuse. The primary objective of this study was to assess the baseline characteristics of minors with PTSD and a history of sexual abuse (PTSD+S) compared with minors with PTSD without sexual abuse (PTSD only). The secondary objective was to evaluate the psychiatric comorbidities and suicidal ideation/attempts between the groups. The National Inpatient Sample database from 2006 to 2014 was analyzed using the code for PTSD and history of sexual abuse. PTSD+S (n = 251) subjects were compared with those with PTSD only (n = 24,243) using test and χ test. Univariate and multivariate logistic regression analyses were performed with suicidal behavior (suicidal ideation/attempt) as the outcome and PTSD with and without sexual abuse, sex, age, and other psychiatric comorbid conditions as independent variables. More patients in the PTSD+S group were nonwhite (52% vs 42%,  < .001) and female (81% vs 66%,  < .001) compared to PTSD only patients. Also, more patients were Hispanic in the PTSD+S group compared to the PTSD only group (28% vs 13%). Major depressive disorder (MDD; 23% vs 14%,  < .001) and substance use disorder (SUD; 20% vs 11%) were more commonly diagnosed psychiatric comorbidities in the PTSD+S group ( < .001). Suicidal behavior (suicidal ideation/attempt) was higher in the PTSD+S group than in PTSD only patients (36% vs 30%,  = .05). Overall, the risk of suicidal behavior was 29% higher in the PTSD+S group than in PTSD only patients (odds ratio [OR] = 1.29,  = .05). In the multivariate analysis, after controlling for age and sex, comorbid diagnosis of MDD (OR = 1.66,  < .001) and SUD (OR = 1.18,  < .001) was associated with increased suicidal behavior. However, PTSD+S showed no association with suicidality (OR = 1.16,  = .29) in the multivariate analysis. Sexual abuse is associated with PTSD and higher risk of comorbid psychiatric illnesses, including MDD, SUD, and suicidal behavior. In-depth research on the relationship between child and adolescent sexual abuse and chronic suicidality is warranted.