Background: Youth have been perceived to have little health needs and limited income to access for health services. In Ethiopia though Sexual and Reproductive Health course was given to all students in selected University but there is limited information on effects of Sexual and Reproductive Health service uptake in the University and this gap may affect weather to scale up of the course or not. Objective: To compare level of sexual and reproductive health services utilization and associated factors among regular youth undergraduate students taken Sexual and Reproductive Health course and not taken the course in Asossa University and Bahir Dar University, 2020 Methods: Institution based comparative cross sectional study was carried out from March10-20, 2020. Multi stage sampling was used among both institution and simple random sampling was used to select a total of 1163 respondents. Data was collected using structured self- administered questionnaires & entered using Epi data and analyzed using SPSS version 23. Bivariate logistic regression analysis was employed to examine association between dependent and independent variables. In bivariate analysis variables whose P value less than 0.2 were considered as candidate variable for the multi-variate analysis. Odds ratio, 95% CI in backward logistic regression was used to identify associated factors with Sexual and Reproductive Health service utilization. Results: A total of 1163 students completed the questionnaire with a total response rate of 97.4%. Males account 375 (65.8%) of the students who attended the course and 407 (69.2%) of the students who did not attended the course. Utilization of reproductive health services in the last 12 months among students those taken SRH course and those not taken Sexual and Reproductive Health course were 66.6% (95% CI: 62.8, 70.4) and 46.4% (95% CI: 42.3, 50.5) respectively Age (AOR= 1.8, 95% CI:1.55,2.02), taking SRH course (AOR= 1.6, 95% CI: 1.11, 2.33), knowledge about SRH service (AOR=2.71, 95% CI: 1.49, 4.95), got information on RH services from peer/friend (AOR=3.9, 95% CI: 2.67, 5.57, experience of discouragement not to use RH services (AOR= 0.4, CI; 0.26, 0.57) and ever encountered fear of being seen by peer/friend during utilization of reproductive health services (AOR=.35, CI: .18, .67) were significantly associated with utilization of Sexual Reproductive Health services Conclusion: In general, it was found that sexual and reproductive health services utilization among those taken SRH course was better than those not taken the course with significant difference