(No attempt is made to explain why seven of the human characters are played by puppets while the other three are played by actual humans.) However, the show includes a considerable amount of profanity in the dialogue as well as including intercourse with puppets.
In addition, the show addresses adult themes that may be deemed inappropriate for younger children, such as racism, pornography, homosexuality and schadenfreude.
Much of the show's ironic humor emerge from its contrasts with Sesame Street, such as illustrating the differences between innocent childhood and the difficult adulthood.
The storyline presupposes the existence of "monsters" and talking animals, and human actors sing, dance and interact with puppets, both human and non-human, as if they were sentient beings, in a light-hearted, quasi-fantasy environment.
One puppeteer sometimes voices two or more puppets simultaneously.
That is, puppets and human characters completely ignore the puppeteers, and the audience is expected to do so as well.
The show draws inspiration from and imitates the format of Sesame Street.
Marx interned at the program early in his career, and all four of the original cast's principal puppeteers—John Tartaglia, Stephanie D'Abruzzo, Jennifer Barnhart and Rick Lyon—were Sesame Street performers (D'Abruzzo returned to Sesame Street after leaving Avenue Q).
Its characters lament that as children, they were assured by their parents, and by children's television programs such as PBS's Sesame Street, that they were "special" and "could do anything"; but as adults, they have discovered to their surprise and dismay that in the real world their options are limited, and they are no more "special" than anyone else.
the show was developed as a stage production at the 2002 National Music Theatre Conference at the Eugene O'Neill Theater Center in Waterford, Connecticut.