Women who have experienced sexual assault, particularly those with more extensive or severe victimization histories, are less likely to use condoms and more likely to contract STIs/HIV than women without such histories. Emerging research also suggests a link between sexual assault histories and engagement in unwanted consensual sex. The Cognitive Mediation Model (CMM) of sexual decision making posits that background factors, such as sexual assault history, influence sexual behavior through cognitive processing within sexual situations. Consistent with this framework, women with more severe victimization histories may perceive their personal safety to be at greater risk during subsequent sexual encounters, leading to different sexual decisions. Sexual abdication, or deferring sexual decisions to a partner, may contribute to adverse sexual health outcomes among women with sexual assault histories. This dissertation tested and extended the CMM using a mixed-methods design examining real-world accounts of recent sexual encounters among cisgender women attending a large public university. For Aim 1, qualitative interviews were conducted with 16 college women (n = 12 with sexual assault histories and n = 4 without such histories) to explore reasons for sexual and condom decision abdication. Multiple reasons for abdication emerged and broadly aligned with the sexual goals described in the CMM, particularly reasons related to perceived relational and sexual health security, avoidance of negative emotional and relational states, and prioritization of partner sexual satisfaction. For Aim 2, a quantitative path model with 115 women both with and without sexual assault histories examined associations among childhood and adolescent/adult sexual assault severity, primary and secondary personal safety appraisals, sexual and condom decision abdication, unwanted consensual sex, and condomless sex. Adolescent/adult sexual assault severity was indirectly associated with unwanted consensual sex through secondary personal safety appraisals. Primary personal safety risk appraisals were indirectly associated with unwanted consensual sex through secondary appraisals and negatively associated with condomless sex through lower condom decision abdication. Partner coercive tactics were positively associated with personal safety risk appraisals and unwanted consensual sex. Overall, this dissertation extends the CMM by identifying personal safety risk appraisals as an important mechanism linking sexual assault history and partner coercion to sexual decision making and sexual health outcomes. Findings suggest that women may perceive personal safety risks within encounters they identify as consensual, highlighting the importance of considering both consent and personal safety concerns in understanding women's sexual behavior following sexual assault.