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It has been hypothesized that statins reduce sex hormone biosynthesis through hepatic inhibition of cholesterol synthesis, which is a precursor of androstenedione and estradiol. Such a reduction has been associated with menstrual irregularities, menopausal disorders, infertility, and low libido, but studies are conflicting. Few studies have evaluated the clinical effects of statins on gonadal-sexual function in women.To compare the risk of gonado-sexual dysfunction in statin users vs. nonusers.This was a retrospective cohort study of all female, adult patients (30–85 years) enrolled in the Tricare Prime/Plus San Antonio catchment area. Using 79 baseline characteristics, we created a propensity score-matched cohort of statin users and nonusers. The study duration was divided into a baseline period (October 1, 2003 to September 30, 2005) to describe patient baseline characteristics and a follow-up period (October 1, 2005 to March 1, 2012) to determine patient outcomes. Statin users were defined as those prescribed a statin for ≥3 months between October 1, 2004 and September 30, 2005. Logistic regression was used to determine the association of statin use with patient outcomes.Outcomes included menstrual disorders, menopausal disorders, infertility, and ovarian/sexual dysfunction during the follow-up period. Outcomes were identified using inpatient or outpatient InternationalClassification ofDiseases, NinthRevision,ClinicalModification codes as defined by the Agency for Healthcare Research and Quality's Clinical Classifications Software.Of 22,706 women who met study criteria, we propensity score-matched 2,890 statin users with 2,890 nonusers; mean age 58 ± 12 years. Statin use was not significantly associated with menstrual disorders (OR 0.97; 95% CI 0.81–1.16), menopausal disorders (OR 0.92; 95% CI 0.83–1.02), infertility (OR 0.79; 95% CI 0.36–1.73), or ovarian/sexual dysfunction (OR 1.18; 95% CI 0.83–1.70).Statin use was not associated with higher risk of gonado-sexual dysfunction in women. Ali SK, Reveles KR, Davis R, Mortensen EM, Frei CR, and Mansi I. The association of statin use and gonado-sexual function in women: A retrospective cohort analysis. J Sex Med 2015;12:83–92.