Objective The aim of this study was to assess the prevalence and associated factors of female sexual dysfunction (FSD) in Lower Egypt. Design A cross-sectional clinic-/hospital-based survey. Setting Five district medical centres in Dakahlia Governorate: Shirbin, Bilquas, Samblawen, Dekrinis and Mansoura City. Population One thousand married women aged between 16 and 49 years. Methods Data were collected by personal interview in a questionnaire format in addition to physical examination (when allowed). Main outcome measures FSD and associated risk factors. Results The response rate was 93.6%. 68.9% of women had one or more sexual problems; however, 23% of the women with sexual problems were not distressed by these issues. 31.5% of women suffered from dyspareunia. 49.6% of the women had decreased sexual desire, 36% had difficult arousal and 16.9% had anorgasmia (primary and secondary). Marital disharmony, ‘hate’ and unfavourable socio-economic circumstances were the most common aggravating factors (28.1%) for sexual dysfunction among the participants, followed by pregnancy-related events (15.7%). Most women (84.5%) received no help for their sexual problems. 90.3% of the women were circumcised. Only 7.1% (46 of 645) of women with sexual problems had received treatment, with no real improvement reported in 58.7% (27 of the 46 women). Conclusions FSD is a highly prevalent problem within the scope of this study. Low reporting rates and very low treatment rates were identified in the sample from Lower Egypt.