Although sexual difficulties related to a history of childhood sexual abuse (CSA) are common, there are no efficacious treatments to address sexual distress. Recent evidence for the benefits of mindfulness, which emphasizes present-moment non-judgmental awareness, in the treatment of women's sexual concerns provided the impetus for this pilot study. Twenty partnered women with sexual difficulties and significant sexual distress, and a history of CSA were randomized to two sessions of either a cognitive behavioral (CBT, n = 8) or mindfulness-based (MBT, n = 12) group treatment (age: M = 35.8 years, range: 22-54 years). Hierarchical Linear Modeling to assess changes in concordance between laboratory-based subjective and genital sexual arousal revealed a significant effect of MBT on concordance such that women in the MBT group experienced a significantly greater subjective sexual arousal response to the same level of genital arousal compared to the CBT group and to pre-treatment. Both groups also experienced a significant decrease in sexual distress. These data support the further study of mindfulness-based approaches in the treatment of sexual difficulties characterized by a disconnection between genital and subjective sexual response.