Study design <p>Cross-sectional study.</p> Objectives <p>Evaluate sexual activity and satisfaction in women with spinal cord disease (SCD) and their associations with urinary incontinence.</p> Setting <p>Outpatient neuro-urology clinics at a tertiary rehabilitation center in Brazil.</p> Methods <p>Ninety-eight women aged ≥18 years with traumatic or non-traumatic SCD were included. Clinical and demographic data were collected through structured interviews. Bladder symptoms were assessed with the Neurogenic Bladder Symptom Score–Short Form (NBSS-SF). Sexual function was evaluated with the Female Sexual Function Index (FSFI), and sexual satisfaction with the WHOQOL-BREF. Sexual activity was defined as partnered sexual activity, with or without intercourse, within the prior six months. Logistic regression identified predictors of sexual activity and satisfaction.</p> Results <p>Mean age was 42.9 (±12.1) years; most cases were non-traumatic (85.7%), mainly multiple sclerosis (55.9%). Urinary incontinence was reported by 52%, severe in 28.6%. Sexual activity was reported by 48 women (49.0%), of whom 58.3% had FSFI-defined dysfunction and 60.4% reported satisfaction. Incontinence was strongly associated with inactivity (72.5% vs. 27.5%, p &lt; 0.001) and lower FSFI scores (16.2 (10.3) vs. 24.4 (9.1), p &lt; 0.001). Urinary continence (OR 5.0, 95% CI, 1.7 to 14.4), younger age (OR 0.93/year, 95% CI, 0.89 to 0.98), and being married (OR 10.9, 95% CI, 3.6 to 33.3) predicted sexual activity and satisfaction.</p> Conclusions <p>Sexual dysfunction and UI were prevalent and interrelated in women with SCD. UI independently predicted inactivity and dissatisfaction.</p>