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Abstract: Background: Female sexual dysfunction (FSD) is diagnosed when an impairment in the sexual response cycle is associated with distress in women. The association between obstructive sleep apnea (OSA) and FSD has been poorly investigated with conflicting results. Aim: To assess the role of OSA in determining FSD in pre menopausal obese women. Methods: Forty-six women underwent standard polysomnography. Data on sexual function and sexual-related distress were obtained using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS). Women with both abnormal FSFI and FSDS scores were classified as having FSD. Results: Thirty-one women were classified as having OSA. Fourteen (30.4%) women had both sexual difficulties and sexual distress resulting in FSD; they showed higher values of sleep time spent with SpO2 <90% (T90 16.8±24.4 vs. 3.2±5.2%; p=0.004). FSD was present in 10 women with OSA (32.2%); in this group T90 was higher (23.5±26.3) in women with FSD than in those without FSD (4.8±5.8; p =0.003). In a logistic multiple regression analysis, T90 was the only factor associated with an increased risk for FSD (odds ratio [OR] 1.07) (confidence interval [CI]) 1.006–1.13]; p=0.03). Conclusions: In premenopausal obese women the presence of FSD is correlated with OSA only when nocturnal hypoxia is present. [Copyright &y& Elsevier]