Problem  Mycoplasma genitalium has been associated with male urethritis. We sought to relate M. genitalium to genitourinary signs and symptoms in women. Method of study  We compared 26 culture‐positive women (group 1), 257 additional polymerase chain reaction‐positive women (group 2), and 107 negative control women. We used logistic regression to evaluate signs and symptoms, controlling for co‐infections, pregnancy, age, and intervention group assignment. Results  Comparing group 1 with controls, we found significantly elevated odds ratios (ORs) for intermediate vaginal discharge (OR = 5.4; 95% confidence interval 1.01, 29.2) and action in response to discharge 3.9 (1.1, 13.5). Non‐significant increases were observed for pathologic vaginal discharge 3.8 (0.78, 18.2), pathologic dyspareunia 1.5 (0.25, 9.0), vaginal odor 2.1 (0.75, 5.7), and cervical mucopus 4.1 (0.74, 22.4). Group 2 results were similar, but showed no increase in cervical mucopus relative to controls. Conclusion  Infection with M. genitalium in women is independently related to increased genitourinary symptomatology.