There is a large body of research documenting sex differences in certain visual-spatial skills, and relating these differences to evolutionary factors. There is also a growing body of work documenting sex differences in design preferences. This article seeks to bring these bodies of work together, presenting a model suggesting that sex differences in visual-spatial abilities may have worked alongside evolutionary pressures to encourage the sex differences observed in design preferences. It will also seek to identify areas in our knowledge where there are gaps, and, from these, suggest areas for further research. It will begin by reviewing the literature on sex differences in visual-spatial abilities, and then consider the literature concerning sex differences in design productions and preferences. From there, it will address possible evolutionary explanations and attempt to tie these different strands of research together.