OBJECTIVE Affective and emotional dysregulation are consistently linked to greater alcohol use and related consequences, including risky sexual behavior. Moreover, these associations are even stronger among women with experiences of sexual assault. The current study tested affect, alexithymia, positive urgency, and negative urgency as predictors of alcohol use, alcohol-related consequences, and risky sexual behavior and the moderating impact of rape history on these associations among a sample of college women. METHODS Participants were 1,005 college women between the ages of 18 and 25. Approximately 20% of the sample (n = 204) reported a history of rape since age 14. RESULTS Positive and negative urgency statistically mediated the associations between negative affect and alexithymia and the alcohol and risky sex outcomes. Positive urgency was directly associated with alcohol use, while negative urgency was directly associated with alcohol-related consequences. Moreover, rape history moderated these associations, indicating that positive affect may be an important protective factor among women who have experienced rape. CONCLUSIONS The current study identified important unique risk and protective pathways that may increase or reduce women's risk for alcohol-related consequences and risky sexual behavior. Importantly, these pathways are comprised of constructs that are malleable and modifiable and can be targeted and changed through intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).