Madonna co-wrote and co-produced the album with a number of musicians, including Mirwais, Mike Dean, Diplo, the Picard Brothers and Jason Evigan, during a process that lasted 18 months.

It deals with political themes including sexism, gun control, freedom of speech, racism and gay rights, similar to her ninth studio album American Life (2003).

Upon reviewing all the songs she had written, Madonna listened to the track again and thought a male voice was needed on it, and asked rapper and singer Swae Lee to sing "Crave" with her.

[21] Anitta was introduced to Madonna by photographer Mert Alas when she was looking to record a song in Brazilian Portuguese and pay tribute to her fans who are native from the country.

[14] On April 15, 2019, a one-minute teaser was uploaded to Madonna's official social media accounts, in which she declares herself as Madame X, an alter-ego the album is named after, which is also the title of a 1908 play written by Alexandre Bisson, as well as an infamous 1884 portrait by artist John Singer Sargent.

[28] The cover for the standard edition features Madonna wearing diamond art deco earrings by Pennisi Jewelry, with azeviche black hair, pale skin, arched eyebrows, thin smile and red lipstick.

[27] Some journalists compared the imagery to that of Mexican painter Frida Kahlo,[30][31][32] while a writer on The Art Newspaper noted that the artwork also referenced Russian performance artist Pyotr Pavlensky, who had previously sewed his mouth shut in a protest.

[39] "I feel that my record, because Lisbon is a melting pot of culture, from Angola to Spain to Brazil to France—I had the pleasure and honour to meet musicians from all these places and be inspired by their music and let it influence me.

[14] Lyrically, Madame X focuses mostly on political themes, such as sexism, gun control, freedom of speech, racism and gay rights, a contrast to her previous works, which were mostly about love and sex.

[15][44] Madonna revealed that the shift on her lyrical content was caused by her being afraid and frightened by "so many things that are going on in the world", but still maintaining an optimistic view for the future, being able to channel her anger and rage in order to create music "full of joy"; she also saw Madame X as a continuation of American Life for its political direction.

[44] Vulture's Craig Jenkins also considered it as a continuation of American Life, as it revisited and restructured some of its political ideas, becoming "an album about the ways the planet sucks right now and how that makes the artist feel".

[1][62] Following a piano interlude, "Dark Ballet" morphs into a "sinister"[42] and "mangled, glitching" fragment from The Nutcracker's Dance of the Reed Pipes, in which she sings in a heavily edited robotic voice, "I will not denounce the things that I have said / I will not renounce my faith in my sweet Lord".

[52][70][71] It features background vocals and drums played by the Batukadeiras Orchestra, and is built on a call and response structure, with the group singing their own solos in the Cape Verdean Creole language.

[77] Opening with strong beats and accelerated rhythm, the next song "Come Alive" pays homage to the music of North Africa, specifically that of the Gnawa tribe; it also contains kuduro influences, with the Tiffin Children's Chorus making another appearance.

[92] A disco and EDM song,[46] "I Don't Search I Find" contains a "chunky '90s house percussion" and "rumbling" bassline,[43][62] that heavily draws influence from Madonna's own work with Shep Pettibone, namely "Vogue" (1990), Erotica (1992), and Confessions on a Dance Floor.

[53][75] Another track present on deluxe editions of Madame X is "Looking for Mercy", a "beautiful and heartfelt" ballad whose introspective lyrics display a vulnerable Madonna "flawed by design" and asking for sympathy.

Over an electropop production, "Funana" finds Madonna singing about idealizing a scenario of union while namechecking several late music icons, among them Aretha Franklin, Whitney Houston, Prince and George Michael in a "Vogue"-style memoriam.

[24] Matthew Barton, also from Attitude, complimented Madonna's marketing team for the announcement as they followed the traditional pre-release model, posting hints of the project to create a buzz between fans alike.

[113] The music video, directed by Nuno Xico, featured Madonna and Swae Lee singing the track on New York City rooftops, surrounded by carrier pigeons.

[69][123] "Dark Ballet" received a video directed by Emmanuel Adjei and stars a Joan of Arc–inspired story-line featuring Mykki Blanco, in which several heads of the church arrest and execute him by burning him at the stake.

[135] On April 19, 2019, "Medellín" was performed by Madonna and Maluma at the Billboard Music Awards;[138] the number featured four virtual versions of her Madame X alter ego—a secret agent, a musician, a cha-cha instructor and a bride.

[152] Later, the Kan Israel Broadcasting Corporation sued Live Nation over the performance, claiming the singer's representatives had violated the terms of their agreement and "reneged on financial promises".

[153][154] On July 1, 2019, Madonna gave a performance on Stonewall 50 – WorldPride NYC 2019 at Pier 97, Hudson River Park, New York City, and sang album track "God Control", "I Rise", "Vogue", and "American Life" (2003); she wore an eye-patch with an X designed in the colors of the rainbow flag, while her background dancers were decked as police officers wielding combat shields.

[167] After several cancellations due to a recurring knee injury, the tour ended abruptly three days before its planned final date, after the French government announced a ban on gatherings of more than 1,000 people to curb the spread of COVID-19 in the midst of the pandemic.

[177] In his "Consumer Guide" column at And It Don't Stop, Robert Christgau viewed Madame X as an indication that Madonna remains a "colorful" professional who releases solid records, even the songs "about forswearing dope and feeling the oppressed … well-intended ideas executed with the appropriate brio and calm, respectively".

[175] El Hunt from NME noted that the album brought a glint in Madonna's eye for the first time since Confessions on a Dance Floor, complimenting its "restless" sound as it "doesn't imitate current pop trends as much as it mangles them into new shapes".

[1] Similarly, Jeremy Helligar from Variety noted that Madonna is "passionate and satisfyingly unconcerned with mass consumption" on her best album since Confessions on a Dance Floor, calling it "her most uncompromising musical statement yet", despite some "lyrical missteps".

[61] Writing for the Evening Standard, El Hunt also had the same opinion, referring to Madame X as the singer's "weirdest" yet best album since Confessions on a Dance Floor, despite sounding like a "complete nightmare in certain places".

[179] Metro Weekly's Sean Maunier deemed the album's tone as "bleak", as it moves "erratically between styles and genres, sometimes all in the very same song", although it delivers "some of the most strange, outlandish and purely self-indulgent work she has ever produced".

[174] Neil McCormick of The Daily Telegraph summarized Madame X as being "a mad mishmash of an album", and criticized its lack of cohesiveness, stating that Madonna was "fighting on too many fronts at the same time".