The United Nations Secretary-General’s adoption of a Guidance Note on Reparations for Conflict-Related Sexual Violence (2014) marks an important supplement to recent normative developments in the area of gender- sensitive reparations. Despite these progressive normative advances, there remain conceptual gaps in the legal and policy framework for reparations addressing conflict-related sexual violence and, consequently, ongoing challenges in the implementation of gender-sensitive reparations, which this article identifies. Challenges include the exclusion of women from legal remedies due to definitional, operational, and enforcement bias in the creation and implementation of reparation regimes. Moreover, a limited understanding of who can be the victim of sexual harm means that violence against men is often unseen and unaccounted for when states and other international actors conceive and implement reparations. This article comprehensively reviews international and domestic practices, addressing legal rules, policy debates, and reparations programming for conflict-related sexual violence. The article concludes that a commitment to transformative reparations is critical to gender-sensitive reparations. Transformative reparations address the immediate reparative needs of survivors of sexual harm, while also being fully cognizant of the social and economic barriers to full equality for women in many societies. Thus, transformative reparations go beyond the immediacy of sexual violence, encompassing the equality, justice, and longitudinal needs of those who have experienced sexual harms. To this end, we propose ten practice-based principles to inform future reparations practice in judicial, peacemaking, and programming contexts for conflict-related sexual violence.