Introduction Lower urinary tract symptoms (LUTS) have a profound impact on physical, social, and sexual well-being. Sacral neuromodulation (SNM) may have a positive effect on sexuality, though few studies have so far evaluated its impact on female sexual function. Aim To prospectively assess changes in sexual function, clinical outcome and quality of life after SNM in female patients with overactive bladder (OAB) and their possible correlation with improvement in urinary symptoms and quality of life indexes. Main Outcome Measures Correlations between differences in Female Sexual Function Index (FSFI) scores and in clinical outcome and correlations between differences in FSFI, SF36, and IQoL scores were evaluated by Spearman’s coefficient. Comparison between preoperative, midterm follow-up (MFU), and last follow-up (FFU) visits were performed by generalized linear model (GLM) for repeated measurements. Methods Between May 2003 and December 2008, 30 consecutive female patients (median age 53 years, range 35–79) with OAB underwent the two-stage procedure of SNM. Only 16 (53%) patients were considered eligible; these completed a bladder diary, the FSFI, the Status of Health questionnaire (SF36) and the Incontinence Quality of Life Index (IQoL) before implantation and on follow-up examinations. Results The results were analyzed before implantation, on MFU (median MFU 22.5 months) and on FFU (median FFU period 36.3 months). Regarding sexuality, the mean improvement in the total FSFI score was 27.9% on MFU and 29.3% on FFU. Only four patients (25%) showed a >50% improvement in global FSFI score on MFU, and 3 (25%) on FFU. A significant correlation was found between clinical improvement and improvement in sexual function. No significant correlation was found between differences in FSFI and quality of life indexes (IQoL and SF36). Conclusion Our results demonstrate that improvement in the quality of sexual function in female patients with OAB correlates with improvement in urinary symptoms.