BACKGROUND End-stage renal disease (ESRD) is a serious illness which has severe negative effects on patients' lives and quality of life. OBJECTIVE To prospectively compare sexual functions between the women with ESRD and healthy women, and also to investigate risk factors that may cause sexual dysfunction in women with ESRD. METHODS The study included 249 women, and the women were divided into two groups: 131 women with ESRD and 118 healthy women as a control group. After obtaining demographic characteristics, sexual function was evaluated with a detailed 19-item questionnaire (The Female Sexual Function Index [FSFI]) assessing sexual desire, arousal, lubrication, orgasm, satisfaction, and pain during sexual intercourse. METHODS The FSFI scores were compared between the two groups, and risk factors that might cause sexual dysfunction were also investigated in the women with ESRD. Results. The mean FSFI total score was significantly lower in the ESRD group (15.9 +/- 10.4) than in the control group (22.2 +/- 6.8) (P = 0.001). The women with ESRD had also significantly lower mean score of sexual desire (P = 0.006), arousal (P = 0.001), lubrication (P = 0.001), orgasm (P = 0.001), satisfaction (P = 0.001), and pain (P = 0.024) than in the control group. To investigate risk factors for sexual dysfunction in the ESRD group, the women having hemodialysis, compared to the women having peritoneal dialysis, had a 5.23 times greater risk of developing sexual dysfunction (P = 0.001). CONCLUSIONS This study shows that women with ESRD have higher risk of sexual dysfunction than healthy women. Thus, women with ESRD should be consulted for sexual dysfunction to improve the quality of life.