International sex trafficking and domestic prostitution are each forms of commercial sexual exploitation (CSE), and CSE typically encompasses a gauntlet of victimization and violence for its victims. Girls and women subjected to CSE are not only damaged during their involvement in the sex industry, but they typically suffer maltreatment and related factors before they enter into it and again as they endeavor to leave it. In this article we review the common risk factors associated with entry into the sex trade industry, the traumas commonly experienced while in the industry and their psychological sequelae, and the challenges surrounding, and longer-term impact of, endeavoring to exit the industry. We describe the complex conditions present at each of these three stages (pre-entry, post-entry, and peri-/post-exit) and how they result in challenges in treating this population. As rates of commercial sexual exploitation increase both nationally and worldwide, there is an urgent need to identify effective interventions for victims and to address the conditions that foster and support CSE.