A retrospective study investigated changes in sexual health after total hip arthroplasty (THA) in 48 heterosexual patients with stiff hips and their partners. VAS scores, Harris scores, and hip range of motion improved significantly after surgery (p < 0.001). The average time to resume sexual activity was 3.6 ± 1.4 months (men 2.9 ± 1.2 months, women 4.5 ± 1.1 months). Sexual frequency increased in 93.7% of patients, 60.4% tried different coital positions, and satisfaction increased from 24% before surgery to 82% after surgery (p < 0.001). The main limitations were limited mobility, pain and fear of damaging the prosthesis. No patient received perioperative sexual health counseling, although 85.4% requested rehabilitation guidance and 60.4% would consider THA due to sexual health impairment. The partners noticed an improvement in the patients' quality of life and sexual health and were willing to adapt. THA positively affected sexual activity, quality of life and relationships in both patients and partners.