Objectives: To evaluate sexual function and psychological state and the factors affecting female sexual dysfunction in predialysis and hemodialysis patients. Design and methods: Forty-seven women with chronic renal failure including 22 predialysis patients, 25 hemodialysis patients, and 30 healthy controls were included in this study. Demographic and clinical variables of the patients were recorded. The sexual functions and psychological states of the patients, assessed by the Arizona Sexual Experiences Scale (ASEX) and Beck Depression Inventory (BDI), respectively, were compared between the groups. Results: Total ASEX scores, ability to reach orgasm, and BDI scores were significantly higher in predialysis and hemodialysis patients than controls, reflecting sexual dysfunction. The patients in the predialysis group were 6 and 3.8 times more likely to develop depressive symptoms compared to the controls and hemodialysis patients, respectively. The predialysis patients who showed depressive symptoms were 24 times more likely to develop sexual dysfunction compared to those without depression. Serum FSH and LH levels were also positively correlated with arousal and erection/lubrication scores in the predialysis patients with depressive symptoms. Conclusion: Female predialysis rather than dialysis patients might be more likely to develop depression. Those patients with depressive symptoms may also be at greater risk of developing sexual dysfunction in which increased gonadotropin levels and age may also be contributing factors. Therefore, psychiatric and gynecologic consultations may be beneficial.