Given documented gender differences in risk factors and manifestations of violence, researchers have advocated for gender-sensitive approaches to violence risk assessment. This study compares male (n = 292) and female (n = 68) forensic psychiatric patients on an array of demographic, clinical, behavioral, and legal variables to gain a clearer understanding of the prevalence of different risk factors and types of violence in this population. We investigate the interrater reliability and item utility of the Historical, Clinical, Risk Management-20 (HCR-20:V2), and examine whether individual HCR-20 items exhibit differential relationships to the tool's summary risk rating across gender. More women carried a diagnosis of borderline personality disorder, whereas antisocial personality disorder, substance use problems and extensive criminal histories were more often noted in men. These clinical differences were reflected in the distribution of HCR-20 item and subscale scores across gender. Interrater reliability was excellent, especially for women. A lack of personal support increased the odds of being deemed high risk in women to a greater extent than in men. We discuss the utility of structured professional judgment tools such as HCR-20 in women, and consider the importance of a gender-sensitive approach to risk assessment.