Objectives: (1) To describe sexual function in women seeking treatment of stress urinary incontinence (SUI), (2) to compare the impact on sexual function of 3 SUI treatments, and (3) to investigate whether nonsurgical treatment of SUI is associated with improved sexual function. Methods: Women with SUI were randomized to continence pessary, behavioral therapy (pelvic floor muscle training and continence strategies), or combination therapy. Sexual function was assessed at baseline and 3 months using short forms of the Pelvic Organ ProlapseVUrinary Incontinence Sexual Function Questionnaire and the Personal Experiences Questionnaire. Successful treatment of SUI was assessed with a patient global impression of improvement. Analysis of variance was used to compare scores between groups. Results: At baseline, sexual function was worse among women with mixed incontinence compared with those with pure SUI. After therapy, successful treatment of SUI was associated with greater improvement in the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire score (2.26 ± 3.24 vs 0.48 ± 3.76, P = 0.0007), greater improvement in incontinence with sexual activity (0.45 ± 0.84 vs 0.01 T 0.71, P = 0.0002), and greater reduction in restriction in sexual activity related to fear of incontinence (0.32 ± 0.76 vs -0.06 ± 0.78, P = 0.0008). Among those successfully treated for SUI, improvement in continence during sexual activity was greater in both the combined therapy group (P = 0.019) and the behavioral group (P = 0.02) compared with the pessary group. Conclusions: Successful nonsurgical treatment of SUI is associated with improvements in incontinence-specific measures of sexual function. Behavioral therapy may be preferred to pessary for treatment of SUI among women whose incontinence interferes with sexual function. Copyright © 2011 by Lippincott Williams & Wilkins.