A subset of men with erectile dysfunction have an underlying neurologic or neurodegenerative condition which directly causes their impairment. The authors briefly discuss the interplay of the CNS, peripheral nervous system and corporal bodies of the penis integral to normal erectile function and how these interactions are disrupted in the setting of various neurologic conditions. Effective therapies for these patients exist in a variety of different forms to include oral or injectable drugs and even surgery. Future treatment strategies will focus on the improvement of existing therapies as well as the invention of new long-term therapeutic options.