Background: We have analyzed the influence of gender on risk of recurrence after a first episode of venous thromboembolism (VTE). Methods: The Cambridge Venous Thromboembolism Study (CVTE) is a single‐center study of a cohort of unselected patients with a first episode of objectively proven VTE. Results: Recurrence rates were significantly higher in men compared with women [log rank χ² = 11.82; hazard ratio (HR) 2.66; 95% confidence interval (CI) 1.49, 4,77; P = 0.0006]. The cumulative recurrence rate at 2 years was 19.2% in men and 7.7% in women. There was no evidence of a difference in recurrence between men with or without thrombophilia (log rank χ² = 0.03; HR 1.08; 95% CI 0.49, 2.37; P = 0.855). The high recurrence rate in men compared with women was still observed when only patients with idiopathic VTE were analyzed (log rank χ² = 4.38; HR 2.31; 95% CI 1.027, 5.20; P = 0.0363). The recurrence risk was highest in men with a first idiopathic event at 25.7% compared with 11.7% for women in the same category. Conclusion: The risk of recurrent VTE is higher in men than in women.