diff --git a/doc/build/changelog/unreleased_13/5685.rst b/doc/build/changelog/unreleased_13/5685.rst
new file mode 100644
index 0000000000..6f98cfa5de
--- /dev/null
+++ b/doc/build/changelog/unreleased_13/5685.rst
@@ -0,0 +1,6 @@
+.. change::
+    :tags: sqlite, usecase
+    :tickets: 5685
+
+    Added ``sqlite_with_rowid=False`` dialect keyword to enable creating
+    tables as ``CREATE TABLE … WITHOUT ROWID``. Patch courtesy Sean Anderson.
diff --git a/lib/sqlalchemy/dialects/sqlite/base.py b/lib/sqlalchemy/dialects/sqlite/base.py
index 5efd0d9c99..aead991479 100644
--- a/lib/sqlalchemy/dialects/sqlite/base.py
+++ b/lib/sqlalchemy/dialects/sqlite/base.py
@@ -583,6 +583,21 @@ or on a per-:class:`_engine.Engine` basis::
 When using the per-:class:`_engine.Engine` execution option, note that
 **Core and ORM queries that use UNION may not function properly**.
 
+SQLite-specific table options
+-----------------------------
+
+One option for CREATE TABLE is supported directly by the SQLite
+dialect in conjunction with the :class:`_schema.Table` construct:
+
+* ``WITHOUT ROWID``::
+
+    Table("some_table", metadata, ..., sqlite_with_rowid=False)
+
+.. seealso::
+
+    `SQLite CREATE TABLE options
+    <https://www.sqlite.org/lang_createtable.html>`_
+
 """  # noqa
 
 import datetime
@@ -1259,6 +1274,11 @@ class SQLiteDDLCompiler(compiler.DDLCompiler):
 
         return text
 
+    def post_create_table(self, table):
+        if table.dialect_options["sqlite"]["with_rowid"] is False:
+            return "\n WITHOUT ROWID"
+        return ""
+
 
 class SQLiteTypeCompiler(compiler.GenericTypeCompiler):
     def visit_large_binary(self, type_, **kw):
@@ -1466,7 +1486,13 @@ class SQLiteDialect(default.DefaultDialect):
     isolation_level = None
 
     construct_arguments = [
-        (sa_schema.Table, {"autoincrement": False}),
+        (
+            sa_schema.Table,
+            {
+                "autoincrement": False,
+                "with_rowid": True,
+            },
+        ),
         (sa_schema.Index, {"where": None}),
         (
             sa_schema.Column,
diff --git a/test/dialect/test_sqlite.py b/test/dialect/test_sqlite.py
index d06cd48f5f..57529aeb6d 100644
--- a/test/dialect/test_sqlite.py
+++ b/test/dialect/test_sqlite.py
@@ -1161,6 +1161,16 @@ class SQLTest(fixtures.TestBase, AssertsCompiledSQL):
             ),
         )
 
+    def test_create_table_without_rowid(self):
+        m = MetaData()
+        tbl = Table(
+            "atable", m, Column("id", Integer), sqlite_with_rowid=False
+        )
+        self.assert_compile(
+            schema.CreateTable(tbl),
+            "CREATE TABLE atable (id INTEGER) WITHOUT ROWID",
+        )
+
 
 class OnConflictDDLTest(fixtures.TestBase, AssertsCompiledSQL):