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Objectives To provide a literature review on sexual function in women living with bladder exstrophy–epispadias complex (BEEC) and to suggest clinical interventions. Method Systematic review of the literature based on the keywords exstrophy, epispadias, sexuality, sexual function, and quality of life. Out of 584 initial articles, 28 were selected as meeting the inclusion criteria. Results Age at first sexual intercourse ranges from 17.7 to 19.9 years, with 72% of women with BEEC being sexually active. Masturbation is reported by 43 to 50%, and ability to reach orgasm is reported by 50% of women with BEEC. Aside from orgasm, 72% experience pleasure during sexual activities. Overall FSFI (Female Sexual Function Index) scores are lower among women with BEEC and below the clinical threshold of 26. Between 67 and 73% report being sexually dissatisfied. Dyspareunia is present in 10 to 50% of women with BEEC and lack of clitoral sensitivity (post clitoroplasty) affects 50% of women with BEEC. Incontinence negatively impacts sexuality for 63%, and 37% report prolapse. While 69% of adults with BEEC report being happy, 88% have urinary or sexual concerns. Almost half of women with BEEC restrict sexual activities or avoid intimacy due to the appearance of their genitals. Holistic, multidisciplinary management, including vaginal stenosis and dyspareunia, which may call for the use of dilators, must take all of these elements into account. Pelvic deformity affecting sexual positions may require occupational therapy to facilitate autonomy and help to adapt environments. For incontinence concerns, the use of anticholinergics prior to intercourse may be considered, and for prolapse, pelvic floor training can be considered to strengthen muscles and improve sexual experiences. Body image, self-esteem, and concerns with concealment and confidence are important components of the condition and should be addressed in psychosexual therapy. Conclusion Data on the sexuality of women with BEEC are highly variable and warrant further research, yet a holistic and multidisciplinary approach may address the impact of BEEC on sexuality.