Worms had been a diocesan town since the early Middle Ages and was therefore the focal point in a diocese that existed until around 1800, extending in a sweeping East-West arc from the western Palatinate region to the river Neckar around Heilbronn. One of the most influential bishops was Burchard (1000-1025), who played a key role in the development of Worms as a blossoming medieval city by commissioning the erection of a new cathedral, by founding seminaries and by holding office as ruler of the city.
The Romanesque cathedral, which shapes the cityscape to the present day, was mainly constructed between around 1125 and 1181 as the most recent of the Imperial Cathedrals (Speyer and Mainz in addition to Worms). Its almost completely preserved, Romanesque structures alone make it one of the most important ecclesiastical buildings of the medieval empire.
The bishops of Worms maintained close ties with the Salian dynasty and the House of Hohenstaufen and were therefore important supporters of imperial dominion in the High Middle Ages. They also cultivated networks far beyond the limits of Worms itself. At the same time they ruled over the City of Worms, although their position had been increasingly eroded since the 13th century by the burgeoning power of the city council that at an early stage asserted its municipal claims as a counterbalance to the special rights afforded to the numerically superior clergy. The virulent conflict concerning issues of taxation and the legal status of the clergy that had raged between the bishop, the cathedral chapter and the remaining clergy residing in the seminaries on the one side, and the town council with its oligarchical constitution on the other, escalated once again shortly before 1500. The council's interest in curtailing the clergy's privileges contributed significantly to the attractiveness and feasibility of introducing the ideas proposed by the Reformation to Worms from 1519/21 onward. The area around the cathedral had again been structurally and artistically refurbished around 1500 under Bishop Johann von Dalberg, a renowned humanist.