Introduction and hypothesis In previous survey studies, women undergoing urodynamic testing (UDT) have reported bother and embarrassment and have provided suggestions for improving the experience. The suggestions include audio distraction and increased privacy, neither of which have been prospectively examined. We report a prospective randomized controlled trial to evaluate the hypothesis that an improved ambience can decrease UDT-related embarrassment and anxiety. Methods A total of 60 participants were recruited to achieve an 80% power to detect a conservative 20-point difference with a significance level of 0.05. Eligible participants were randomized to one of two conditions: dim lighting with light instrumental music (modified group, 30 patients), or no music and standard lighting (standard group, 30 patients). The aim of the dim lighting and music was to provide an increased sense of privacy and audio distraction based on participant feedback in previous studies. Results The study was complete with 60 participants. Patients in both groups reported less embarrassment after UDT. However, patients in the modified group showed a greater decrease in embarrassment scores (9.72 mm) than patients in the standard group (1.3 mm; p  = 0.33). Although the study was under-powered, the difference found approached clinical significance. Conclusions Simply dimming the lights and providing music during UDT resulted in a decrease in embarrassment scores of almost ten points. This low-cost and simple measure improved patient experience.