To examine prevalence and risk factors associated with primary dysmenorrhea among Chinese female university students in Hunan province, China. A cross-sectional study. Female university students in Changsha city, Hunan province, China. Four thousand six hundred six female individuals selected using a multistage cluster random sampling method. A self-administered questionnaire, which included sociodemographic information, lifestyle habits, emotional characteristics, and menstruation pattern, was used to collect data. Information about menarche, body mass index, cycle length and regularity, primary dysmenorrhea, physical exercise, depression, and anxiety. The prevalence of primary dysmenorrhea was 41.7% (1921/4606)among Chinese female university students. Multivariate binary logistic regression indicated that being a minority (odds ratio [OR], 1.335; 95% confidence interval [CI], 1.083-1.646), underweight (OR, 1.249; 95% CI, 1.08-1.42), annual household income less than 80,000 CNY (OR, 1.169; 95% CI, 1.018-1.342), maternal history of dysmenorrhea (OR, 2.553; 95% CI, 2.236-2.915), age at menarche younger than 12years (OR, 1.161; 95% CI, 1.013-1.329), irregular menstrual cycle (OR, 1.216; 95% CI, 1.063-1.391), and skipping breakfast (OR, 1.294; 95% CI, 1.124-1.490) were associated risk factors of primary dysmenorrhea. The prevalence of primary dysmenorrhea among Chinese university students is relatively high. Various risk factors were identified that associated with primary dysmenorrhea. More effort and attention should therefore be directed toward this health problem in China.