BackgroundSexual activity is an important component of quality of life. To date, no studies have examined the impact of stem design on return to sexual activity (RTS) and quality of sex life after total hip arthroplasty (THA).MethodsA questionnaire was designed to assess preoperative and postoperative sexual habits, joint awareness and physical activity in working-age patients undergoing short-stem (n= 176) or straight-stem (n= 97) THA.ResultsNo differences were noted in time until RTS based on the stem design (short stems vs. straight stems; 6 [IQR: 4–10] vs. 6 [4–10] weeks;p= 0.996). Multivariate analysis revealed that higher patient BMI (p= 0.04), female gender (p< 0.001) and lower FJS-12 (p= 0.006) were significantly associated with delayed RTS. Improved hip mobility and reduced pain mainly contribute to improved quality of sexual activity postoperatively.ConclusionThis study, hence, indicates that stem design has no impact on time until resumption of sexual activity in patients < 65 years. Female obese individuals who are aware of their artificial joint in daily life are at increased risk of delayed RTS after surgery.Level of evidenceLevel III, retrospective cohort study.