Objective Visual hallucinations (VHs) are among the most striking features of dementia with Lewy bodies (DLB). We investigated gender differences in the association and presentation of VHs in DLB. Methods A cross‐sectional analysis of baseline data from a prospective, longitudinal study on dementia was performed. Cumulative frequency, 1‐month frequency, and phenomenology of VHs were summarized and compared between female and male patients with DLB. Gender differences in the factors associated with VHs were investigated in patients with and without hallucinations. Results A total of 152 patients including 65 (42.8%) women and 87 (57.2%) men were analyzed. The cumulative and 1‐month frequencies of VHs were 60% and 55.4%, respectively, in women and 44.8% and 41.4%, respectively, in men. Adjusting for age and disease severity resulted in the inclusion of more women in the VH group [odds ratio (OR) = 2.33, p = 0.028)] than in the non‐VH group. In female participants, older age (OR = 9.16, p = 0.003) and higher neuropsychiatric inventory score (OR = 4.89, p = 0.009) were associated with VHs, whereas in male participants, more severe dementia stage (clinical dementia rating 2–3 versus clinical dementia rating 0.5, OR = 6.22, p = 0.008) and higher rates of using antipsychotics (OR = 9.64, p = 0.047) were associated with VHs. Conclusion The frequencies of 1‐month and cumulative VHs were high in DLB, which indicated a high prevalence as well as a high persistency of VHs in DLB. The patterns of factors associated with VHs differed between female and male patients. Copyright © 2017 John Wiley & Sons, Ltd.