Studies have extended and applied lifestyle-routine activity theory (L-RAT) to direct-contact sexual violence (SV). Yet, operationalizations of theoretical concepts—exposure, proximity, target suitability, and guardianship—have not been consistent across studies within this context, and therefore the ultimate conclusions on the robustness of the theory remain an open empirical question. In this systematic review, we compile scholarship on the application of L-RAT to direct-contact SV to identify how core concepts have been operationalized as well as their association with SV. Studies met the inclusion criteria if they were published before February 2022, examined direct-contact sexual victimization, and explicitly categorized measures into one of the aforementioned theoretical concepts. Overall, 24 studies met the inclusion criteria. Certain factors, such as alcohol and substance use as well as sex behaviors, emerged as consistent operationalizations of exposure, proximity, target suitability, and guardianship across studies. Alcohol and substance use, sexual orientation, relationship status, and behavioral health conditions were common correlates of SV. Nevertheless, there was considerable variability in measurement and significance, clouding how these factors affect risk of SV. In addition, several operationalizations were unique to single studies, reflecting context-specific operationalizations about the population and research question at hand. Conclusions drawn from this work have implications for the generalizability of the body of knowledge related to the application of L-RAT to SV and identify the need for systematic replication efforts. Implications for future research, especially as it relates to replication efforts and claims around generalizability, are discussed.