There has been little attention to sexual dysfunction (SD) in women undergoing hemodialysis (HD), therefore few studies are found in this field. The aim of this study was to determine the incidence of SD, assess its association with biochemical factors, employment and educational status, economic situation, depression, anxiety, and medication. End stage renal disease (ESRD) married women aged 18 to 60 years presenting to Tehran University of Medical Sciences (TUMS) hospitals’ (Imam Khomeini, Sina, and Baharloo) from April to September 2017 were included in the study. Female Sexual Function Index (FSFI) questionnaire was used to evaluate SD. Patients were divided into two groups with SD (scores≤28) and without SD (scores˃28). Hospital Anxiety and Depression Scale (HADS) questionnaire was used to investigate anxiety and depression; patients with scores equal to or more than 11 were implied as depressed or anxious. Demographic data, duration of dialysis, ESRD causes and biochemical tests were also collected. Thirty patients (81.1%) out of 37 showed SD who were older, had lower educational and economic status, had higher hemoglobin levels and used erythropoietin products and Venofer® (iron sucrose injection) less; most of these patients were housewives. The incidence of SD among patients was high. Erythropoietin and Venofer use was less frequent in patients with SD compared to the other group. This suggests that these two products have a role in treatment of SD rather than the treatment of anemia. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(4):244-252.