BackgroundThe target population for women’s sexual health services in China was unclear. To identify high-risk individuals with psychological barriers to sexual health-seeking behaviors and those at high risk of hypoactive sexual desire disorder (HSDD), we investigated correlates of Chinese women’s unwillingness to communicate sexual health, the shame of sexual health-related disorders, sexual distress, and HSDD.MethodsAn online survey was conducted from April to July 2020.ResultsWe received 3443 valid responses online (effective rate 82.6%). Participants were mainly Chinese urban women of childbearing age (median 26 years old, Q1-Q3 23–30). Women who knew little about sexual health knowledge (aOR 0.42, 95%CI 0.28–0.63) and were ashamed (aOR 0.32–0.57) of sexual health-related disorders were less willing to communicate sexual health. Age (aOR 4.29, 95%CI 2.26–8.17), low income (aOR 1.52–2.11), family burden (aOR 1.34–1.43), and living with friends (aOR 1.39, 95%CI 1.02–1.91) were independent correlates of women’s shame about sexual health-related disorders while living with a spouse (aOR 0.66, 95%CI 0.51–0.86) or children (aOR 0.77, 95%CI 0.62–0.96) were correlated with less shame. Age (aOR 0.98, 95%CI 0.96–0.99) and a postgraduate degree (aOR 0.45, 95%CI 0.28–0.71) were linked with less sexual distress of low sexual desire while having children (aOR 1.38–2.10), intense work pressure (aOR 1.32, 95%CI 1.10–1.60) and heavy family burden (aOR 1.43, 95%CI 1.07–1.92) increased women’s odds of having distress. Women with a postgraduate degree (aOR 0.42, 95%CI 0.19–0.90), more knowledge about sexual health (aOR 0.53–0.67), and decreased sexual desire caused by pregnancy, recent childbirth, or menopausal symptoms (aOR 0.60, 95%CI 0.41–0.85) were less likely to have HSDD, while they were more likely to have HSDD when their decreased sexual desire was due to other sexual issues (aOR 2.56, 95%CI 1.84–3.57) and partners’ sexual problems (aOR 1.72, 95%CI 1.23–2.39).ConclusionSexual health education and related services need to focus on psychological barriers of women with older age, insufficient knowledge of sexual health, intense work pressure, and poor economic conditions. The medical staff need to pay attention to the sexual health of women with intense work or life pressure and a history of gynecological disease. Low sexual desire is not equal to the sexual desire problem, which should be noticed in the future.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12905-023-02357-5.