Each of these paths chronicle Hisao's deepening and eventually romantic relationship with one of the five main female characters (or lack thereof), which may variously end well, badly, or neutrally.
From January 2007, the sketch was discussed extensively on the 4chan image board, and a development group was assembled from users of 4chan and other internet communities, who are of various nationalities; not necessarily Japanese.
The game uses a traditional text and sprite-based visual novel model with an ADV text box.
Katawa Shoujo contains adult material, and was created using the Ren'Py scripting system.
The full visual novel has been released officially in English, French, Spanish and Japanese.