Warner Bros. Records and Time Warner executives were reluctant to allow Madonna to make such a book, and though they eventually gave her permission, they remained greatly opposed to the idea. Madonna was made to sign an agreement that forbade her from including any photographs depicting religious imagery, bestiality, or child pornography.
Not long after signing this agreement Madonna founded Maverick, a multi-media entertainment company. Since by contract she had total artistic control over any of the work released by Maverick, the agreement she signed with Time Warner concerning what not to do in Sex became obsolete. As a "tongue-in-cheek" way of demonstrating her power to the executives who had so vehemently opposed the book, Madonna included two photographs that "broke the rules"—a photo where she is tied à la SM on a low cross-shaped table surrounded by candles with a large crucifix displayed on the wall behind her, and another photo of her kneeling on the ground with a dog underneath her on its back, creating the impression that she is straddling the animal while it is giving her oral sex. However, should one look closely at the photograph, one will see that Madonna is not straddling the dog's head at all, but rather kneeling on both knees beside the dog.
Warner Bros. commented that Sex was very difficult to produce, requiring contributions from many different printing and publishing companies, with Mighty Dimension Inc. coordinating the project—LTI, Bishop Studio, Master Eagle Graphic Design, and Shorewood Packaging, all based in New York City; as well as Laserscan Inc. in Phoenix, Arizona; Benson and Palmer in Newport, Rhode Island; Mohawk Papermills in Cohoes, New York; CH Packaging Company Inc. in Merrill, Wisconsin; and Nicholstone in Nashville, Tennessee. At some point while the book was being produced some of the photographs were stolen, prompting an FBI investigation that quickly recovered the photos. In the credits of the book Madonna thanks the FBI for " ... rescuing photographs that would have made J. Edgar Hoover roll over."
Madonna had originally intended to call the book X but changed her mind when Spike Lee's upcoming film Malcolm X began to be promoted—the film was released three weeks after the book, and inspired the fashion trend of wearing hats and shirts with a large X in honor of Malcolm X. Madonna wanted the book to be of an oval shape, but the printing and manufacturing of such a book would have been too expensive. In the end, the original design for the X title and shape of the book were only retained on the back cover (see below) and on the accompanying CD and its packaging.

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