Sexual dysfunction due to inadequate or poorly sustained erections is a common problem among patients with spinal cord injury (SCI). While penile prostheses have provided adequate treatment for many patients, the complication rate in spinal cord injured patients remains high and they have not received widespread acceptance among SCI patients or the physicians treating them. Recently, intracavernous injections of vasoactive medications have proved beneficial for treating patients with erectile dysfunction. In the current study, we evaluated 40 SCI patients and 116 patients with vascular based impotence who had been followed for a minimum of 1 month while utilising intracavernous injections of phentolamine and papaverine. SCI patients with neurogenic based erectile dysfunction are significantly different from vascular impaired patients. SCI patients are younger and have been impotent for a longer period of time when treatment is sought. Furthermore, the dose of medication required is significantly less for SCI patients. The time of erection is longer and the quality of erection is better in neurogenic based impotence. Results with this treatment in SCI appear to be quite good with short term followup and long term evaluation of this methodology in SCI appears warranted. © 1989 International Medical Society of Paraplegia.