Definitions of orgasm remain varied, and physiologic markers have not been standardized or consistently applied. The occurrence of orgasm after spinal cord injury (SCI) has been documented for a number of years; however, in the recent past, the neurologic and autonomic correlates associated with orgasm after SCI have been investigated. In this article we review recent studies pertaining to the occurrence of orgasm after SCI. Laboratory-based assessments of orgasmic responsiveness of women and men with known levels and degrees of SCI have shown the effects of orgasm on peripheral autonomic responses and the effects of varying injury patterns on the ability to achieve orgasm. A spinal pattern generator has also been identified that mediates ejaculation in male rats and responses similar to orgasm in female rats. Taken together, these findings suggest that retraining reflexic orgasm through vibratory or other forms of neural stimulation may provide a means to remediate orgasmic dysfunction in persons with SCI.