The majority of the story takes place at the fictional Yamaku High School for disabled children, located somewhere in modern Japan. Hisao Nakai, a normal boy, has his life turned upside down when a long-dormant cardiac dysrhythmia forces him to transfer to a new school after a long hospitalization. Despite his difficulties, Hisao is able to find friends, and perhaps love.
The gameplay of Katawa Shoujo is choice-based, with the player reading through text and occasionally making decisions that impact events or dialogue within the story. Depending on the choices made by the player, the story branches into forks either chronicling Hisao's deepening, and eventually romantic, or eroge relationship with one of the five heroines, each of which may variously end well, badly, or neutrally (or bittersweetly),or with none of them.
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