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Prior research has identified traumatic experiences and substance use as risk factors for adolescent engagement in sexual risk‐taking; however, these studies have relied upon subthreshold or non–dually diagnosed samples. The present study examined differences in sexual risk behaviors between adolescents with a substance use disorder (SUD) and co‐occurring posttraumatic stress disorder (PTSD) versus those with an SUD and another co‐occurring psychiatric disorder. Participants were 269 adolescents who met the clinical screening criteria for an SUD and at least one psychiatric disorder. Bivariate comparisons and generalized linear models were used to compare sexual risk behaviors in participants with co‐occurring PTSD (30.0%) and those with a different psychiatric disorder (70.0%). Participants with co‐occurring PTSD were twice as likely to have multiple sex partners during the same period compared to those without PTSD, odds ratio (OR) = 2.35, p = .012. They also reported, on average, over twice the incidence rate of unprotected sexual encounters, incidence rate ratio (IRR) = 2.06, p = .034, and a 51.0% higher incidence of sexual risk behaviors, IRR = 1.51, p = .008, than participants without co‐occurring PTSD. The results suggest dually diagnosed adolescents with co‐occurring PTSD are more likely to engage in sexual risk behaviors than those with a different co‐occurring disorder, placing them at higher risk for adverse health effects, such as sexually transmitted infections and unplanned pregnancies. As such, this population is likely to benefit from targeted trauma‐informed sexual health education programs focused on sexual risk reduction. [ABSTRACT FROM AUTHOR]