© 2015 Elsevier Ireland Ltd. All rights reserved.Objectives Investigate the effects of pre-operative menopausal status and HRT use on sexual outcomes following risk-reducing salpingo-oophorectomy (RRSO). Study design Cross-sectional study of 119 women who underwent RRSO between 2009 and 2014. Main outcome measures Data was collected via a questionnaire and serum test for testosterone and free androgen index (FAI). The questionnaire comprised demographic data and validated measures of sexual function, sexual distress, relationship satisfaction, body image, psychological stress, menopause quality of life and general quality of life. Results Rates of sexual issues were similar despite menopause status at operation. Women who were pre-menopausal at operation (mean age = 44years ± 5) had significantly higher rates of sexual distress (p = 0.020), dissatisfaction with sex life (p = 0.011) and bothersome sexual menopause symptoms (p = 0.04) than women who were post-menopausal (mean age = 55years ± 7). Pre-menopausal women reported higher psychological distress from surgery (p = 0.005) and poorer emotional (p = 0.052) wellbeing. HRT use reduced the rates of dyspareunia (p = 0.027) and the severity of sexual menopausal symptoms (p = 0.030). Androgen levels were not significantly associated with desire or arousal scores. Conclusions Regardless of menopausal status at operation, women experienced the same sexual issues at equivalent rates. However, pre-menopausal women reported higher sexual distress and dissatisfaction with sex life. Pre-menopausal women also had greater psychological distress and poorer emotional function.