Background <p>Human papillomavirus is the most common infection transmitted through sexual contact. The occurrence of genital warts (GWs) can affect patients’ sexual life.</p> Objective <p>This study was performed to compare sexual distress and sexual avoidance in women with and without GWs.</p> Methods <p>This case‒control study was conducted on 136 women with GWs and 136 women without GWs in the dermatology and gynecology clinic of Shahid Faqihi Hospital, Shiraz University of Medical Sciences, Iran, from April to November 2023. Data were collected via a demographic questionnaire, a revised version of the female sexual distress scale, and a sexual avoidance questionnaire and were analysed via Chi square test, independent t-test and a generalized linear model with SPSS software version 22.</p> Results <p>The mean scores of sexual distress were 26.16 ± 13.97 and 8.50 ± 6.42 in the case and control groups, respectively. There was a significant difference between the two groups in terms of the sexual distress score (<i>P</i> &lt; 0.001). The mean sexual avoidance scores were 9.79 ± 4.00 and 9.48 ± 2.85 in the case and control groups, respectively. There was no statistically significant difference between the two groups in terms of the sexual avoidance score (<i>P</i> = 0.465). Women with genital warts (<i>P</i> &lt; 0.001), college and above education (0.036), dyspareunia (<i>P</i> = 0.003), and higher age at first sexual intercourse (<i>P</i> = 0.004) had a significantly higher sexual distress score.</p> Conclusions <p>Women with GWs experienced more sexual distress, but their degree of sexual avoidance was not significantly different from that of women without GWs. These results could have important applications in the assessment of women with GWs. Healthcare providers should pay more attention to women’s sexual distress, implement appropriate interventions to diminish it and prevent the occurrence of undesirable psychosexual consequences such as sexual avoidance.</p>