Background and AimAlthough various surveys have been conducted for sexual problems, there is a lack of population‐based studies on sexual distress in Iran. Thus, we sought to determine the prevalence and predictive factors of sexual distress in this population.MethodsOverall, 1000 married women aged 16–49 years were enrolled in this study using the two‐stage cluster sampling method. To identify sexual distress, the female sexual distress scale‐revised (FSDS‐R) was completed. The predictive factors were assessed using a checklist.ResultsA total of 318 women (31.8%) suffered from sexual distress. Among socio‐demographic factors, satisfaction with marriage (p = 0.001), among personal factors history of infertility and fear of contracting sexually transmitted infections (p < 0.01), and among sexual and interpersonal factors satisfaction with the level of sexual desire (p = 0.01), pain during sexual intercourse (p < 0.01), premature ejaculation disorders in the partner (p < 0.05), and sexual satisfaction (p < 0.001) were significantly associated with sexual distress.ConclusionClinicians should evaluate sexual distress comprehensively and consider all the related dimensions. The high overall prevalence of sexual distress, with or without an identifiable dysfunction, signals the importance of health professionals being adequately prepared to discuss sexual health concerns.