The aim of this cross-sectional study was to examine associations between sex, exposure to potentially traumatic events and pre-treatment symptomatology in trauma-affected refugees. We analyzed pre-treatment self-report questionnaires and clinical interviews from 318 refugees with post-traumatic stress disorder (PTSD) in a specialized mental health clinic. Results show that twice as many females reported exposure to family violence (p = .001) and sexual abuse (p = .004), whereas men were at least three times as likely to report exposure to torture (p <0.001), imprisonment (p < .001), and combat (p < .001). Men reported exposure to more trauma types (p < .001). Women reported more depression (p = .001), anxiety (p = .008) and somatization (p = 0.001), whereas men were diagnosed significantly more with enduring personality change after catastrophic experience (p < .001). Additionally, trauma burden was significantly associated with PTSD (p = .001) and depression (p = .039) scores for women but not men, and imprisonment was associated with a higher PTSD score in women (p = 0.037) but not men. Our findings highlight sex differences in trauma exposure and symptomatology in trauma-affected refugees in host countries, that should be considered when developing mental health interventions for this underserved population.