Madonna wrote all the lyrics, added some melodies to the composition, and recorded a demo on a cassette.
Leonard was working with Michael Jackson, on some transcriptions for his Bad album, when Penn called him to come to Foley's home.
Adam Sexton, author of Desperately Seeking Madonna: In Search Of The Meaning Of The World's Most Famous Woman, felt that "Live to Tell" made a provocative companion to "Papa Don't Preach", the second single from the album.
He added that "Madonna appropriately measured the safety of silence against the urge to unburden herself." Sexton also complimented the production, saying that the "music itself suggests a threatened annihilation, a fact that makes it more haunting." Allen Metz and Carol Benson, authors of The Madonna Companion: Two Decades of Commentary, felt that the track expanded Madonna's musical horizons.
"Live to Tell" was originally an instrumental composed by Leonard for the score of Paramount's romantic drama film Fire with Fire.
"My managers represented the guy who was directing the film; it was his first film.
This toned down blond appearance was again inspired by Marilyn Monroe.
I wrote a theme and I said, 'What if I could get Madonna to write the lyrics for it? who decided to use it for At Close Range, the new film starring her then-husband, actor Sean Penn.
It is also about being strong, which Madonna recalled in an interview that she thought about her relationship with her parents, while writing the lyrics.
The music video, directed by James Foley, shows Madonna's first image makeover, featuring her with a cleaner look, shoulder-length wavy golden blond hair, conservative wardrobe and subtle make-up.
It later appeared on compilation albums The Immaculate Collection (1990), Something to Remember (1995), and Celebration (2009).
A pop ballad, the song includes instrumentation from guitars, keyboards, drums and a synthesizer, and its lyrics deal with deceit, mistrust and childhood scars.