Abdominal aortic aneurysms have an incidence that is approximately four to six times higher in men than in women. However, the incidence in women also rises with older age, although starting later in life than in men. There are also sex differences in the risk of rupture and in outcomes after endovascular and open abdominal aortic aneurysm repair. Various explanations have been proposed. Women historically have been under-represented in clinical trials to evaluate the differences between the sexes. We present a review of current recommendations and recent literature to help identify some of these differences.