Women with an inherited BRCA mutation are at significantly increased risk for breast and ovarian cancer, often diagnosed at an earlier age than sporadic cancers. Prophylactic surgery, with bilateral mastectomy and/or bilateral prophylactic salpingo-oophorectomy, represents an option for risk reduction. The purpose of this study was to explore quality of life, sexual functioning, menopausal symptoms, psychological well-being and satisfaction with risk management decisions for BRCA-positive women ages 21 to 50 (M = 38.4 years), without a personal history of cancer. A web-based, cross-sectional study design was utilized to compare women opting for any prophylactic surgery (n = 160) with those without a history of prophylactic surgery (n = 71). Quality of life (per the Quality of Life Index, Self-Anchoring Striving Scale and Body Image Quality of Life measures) and Psychological General Well-Being Index scores were essentially the same across the entire study sample. While controlling for age, prophylactic surgery (PS) predicted more severe symptoms of sexual dysfunction as measured by the Female Sexual Functioning Index (total score, Desire, Arousal, Lubrication and Satisfaction domains). Similarly, PS predicted menopausal symptoms and sleep difficulties. Women who had not undergone any prophylactic surgery had higher levels of Stigma and lower levels of Mastery, as measured by the BRCA Self-Concept scale. Prophylactic surgery also predicted higher levels of Satisfaction with Decision for hereditary cancer risk management. Findings from this exploratory study provide insight into the quality of life, sexual functioning and psychological well-being for unaffected, BRCA-positive women. Additional research is needed to examine sexual functioning prospectively, to further investigate the potential sequelae of risk-reducing surgery.