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Background Sexual dysfunction is an under-recognised but important concern among women with inflammatory bowel disease (IBD). We aimed to determine the prevalence and predictors of sexual dysfunction among women with IBD compared with age-matched controls in a low- and middle-income country.Methods This was a cross-sectional, case–control study conducted in north India between January and June 2025. Sexually active women with IBD and age-matched controls were enrolled. Sexual function was assessed using the Arizona Sexual Experiences Scale. Clinical, demographic, reproductive and psychosocial variables were recorded. Disease activity was assessed using the partial Mayo Score (ulcerative colitis) or Harvey-Bradshaw Index (Crohn’s disease). Logistic regression identified independent predictors of sexual dysfunction in the IBD cohort.Results 98 women with IBD (median age 43 years) and 60 controls (median age 43 years) were included. The prevalence of sexual dysfunction was significantly higher in the IBD cohort than in controls (83.7% vs 41.7%, p<0.001). Domain-specific impairments in the IBD group were most pronounced in desire, arousal and lubrication (all p<0.001), with no significant differences in orgasmic domains. On multivariate analysis, diagnosis of IBD prior to marriage was independently associated with lower odds of sexual dysfunction (OR 0.055, 95% CI 0.004 to 0.73, p=0.03). No significant associations were observed with disease subtype, activity, extent, medications, surgical history or psychological comorbidities.Conclusions Sexual dysfunction is highly prevalent among women with IBD, particularly affecting early stages of the sexual response cycle. Determinants extend beyond inflammatory activity, highlighting the need for routine sexual health assessment in IBD care.