Background <p>Despite the growing evidence of increasing divorce rates and marital distress among Egyptian couples, there are scarce studies that have explored marital satisfaction in Egypt. This study aimed to assess marital dissatisfaction, utilization of marital counseling services, and attitude toward seeking these services among married women in Upper Egypt.</p> Methods <p>A cross-sectional study design was applied. An Interviewer-administered questionnaire was filled out by 540 formally married women attending outpatient clinics at Aswan University Hospital. It inquired about personal data, the Marital Satisfaction Scale (MSS), whether marital counseling services were utilized, and attitudes toward seeking such services.</p> Results <p>The median and range values of total MSS and attitudes towards seeking marital counseling services were 24 (1–87) and 3 (0–7), respectively. The prevalence of utilizing marital counseling services was 8%. Poor or unknown perception of health was significantly associated with high marital dissatisfaction scores (adjusted ß = 11.959, 95% CI:7.974–15.945). The associates of a positive attitude towards using services were religion, a high education level, a professional occupation, previous consultation with a specialist, and a high marital dissatisfaction score.</p> Conclusions <p>Women in Upper Egypt have low to moderate levels of marital dissatisfaction. Poor health perception is positively linked to marital dissatisfaction. There is a low utilization of marital counseling services. High perception of marital dissatisfaction and some women’s sociodemographic features are related to the positive attitude toward utilization of marital counseling services. There is a need to integrate qualified marital counseling services with all its social and health aspects within maternal health care in Egyptian society and encourage women to use these services.</p>