The objective of this cohort study was to compare morbidity, quality of life, and sexual function in stress-incontinent women treated with tension-free vaginal tape (TVT) versus tension-free vaginal tape obturator (TVT-O) in a group of 329. Preoperative scores of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were compared to those from a mailed, postoperative questionnaire. The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-12) and three additional questions were also included in the mailing. Of the initial 329 patients, 239 (73%) completed the questionnaire with a mean follow-up of 14.7 months. Complications, return to normal voiding, and operative time were less in the TVT-O group. Postoperative PISQ-12 scores and improvements in the UDI-6 and IIQ-7 were comparable between groups. The TVT-O procedure appears to be as effective in improving incontinence-related quality of life as the TVT. No differences in sexual function were demonstrated between groups.