The music of the sexually themed opera combines influences ranging from Alban Berg, Igor Stravinsky, and Benjamin Britten to Kurt Weill and the tangos of Ástor Piazzolla.

Describing the overall impact of the libretto and the theatricality of the entire production, Alex Ross notes: Hensher seized the opportunity to create the first onstage blow job in opera history, but he also twisted the story into something more generalised and expressionistic: Margaret becomes a half-comic, half-tragic figure, a nitwit outlaw.

There were clear parallels with Alban Berg’s epic of degradation, Lulu [...] The libretto reads like a nasty farce, but it takes on emotional breadth when the music is added.

With a few incredibly seductive stretches of thirties-era popular melody, Adès shows the giddy world that the Duchess lost, and when her bright harmony lurches down to a terrifying B-flat minor he exposes the male cruelty that quickened her fall.

[citation needed] From 11 to 22 June 2008, it was performed at the Linbury Studio Theatre in the Royal Opera House, London, with the Southbank Sinfonia conducted by Timothy Redmond, and Joan Rodgers as the Duchess.

[citation needed] The U.S. staged premiere was at the Aspen Music Festival on 25 July 1997,[2] conducted by the composer, with Máire O'Brien as the Duchess, Heather Buck, and Allen Schrott, directed by Edward Berkeley.