Background <p>Melasma is a well-established reason of psychosocial problems as well as other dermatoses. Unlike common psychological morbidities, such as depression and anxiety, sexual dysfunction (SD) has been scarcely explored. We aimed to assess the occurrence of SD in melasma using a prospective case-control study.</p> Methods <p>Sexual function of melasma patients (Group I) and healthy controls (Group II) were compared using Female Sexual Function Index (FSFI). Severity of melasma was assessed using Modified Melasma and Area and Severity Index (mMASI). Age in both groups and severity in Group I were divided into subgroups. Possible effects of these variables on FSFI scores were analysed.</p> Results <p>109 (55 in Group I; 54 in Group II) patients were included. Median FSFI scores of Group I were significantly lower than Group II (27,3 vs. 29,4). Arousal, orgasm and satisfaction were significantly lower in Group I. Median total FSFI scores and percentage of SD were not influenced by age and severity of melasma. Patients with mild melasma had better lubrication results than patients with moderate and severe melasma. Pain/discomfort domain score was higher in patients with severe melasma.</p> Conclusions <p>Dermatologists should keep in mind that melasma, particularly on face, as well as other dermatoses, may also impair the females’ self-esteem and relationships, thereby affect sexual well-being and these patients should be evaluated in a multidisciplinary approach, if necessary. We think our study highlights the need for a more detailed approach to the further studies of SD in females with melasma.</p>