The present modalities available for the medical treatment of patients with neurogenic impotence include: 1) intracavernosal injection of vasoactive agents, 2) topical application of vasoactive drugs via paste or plaster, including intraurethral application and 3) oral administration of vasoactive drugs. Intracavernosal injection pharmacotherapy represents the most common form of treatment. Patients enter a pharmacologic erection program including: 1) initial office testing, during which the safety and efficacy of vasoactive drugs is established and the appropriate technique of self-injection is taught, 2) initial home use by the patient, during which safety and efficacy at home is established and 3) longterm home use and longterm follow-up by the doctor or the nurse to monitor longterm safety and efficacy. Patients with neurogenic impotence may require several special considerations when performing intracavernosal injections. In cases of upper extremity weakness or when there is a lack of upper extremity fine motor control, it may be more appropriate for the partner to perform the intracavernosal injections. Patients with neurogenic impotence must be cautioned against the complication of priapism, a frequent development in the presence of normal hemodynamic parameters. A literature review of satisfaction, complications and drop-out incidence, as well as our personal experience with 62 such patients, confirms the safety, reliability and effectiveness of the intracavernosal injection therapy. Alternative systems for the delivery of vasoactive agents to the corpora include topical application via plasters or paste and intraurethral application via ointments. Vasoactive agents utilized in alternative delivery systems have included nitroglycerin, prostaglandin E2 and minoxidil. The main advantage is the lack of invasiveness while the main disadvantage is the reduced effectiveness of the penile erection. Oral drugs, like yohimbine and trazodone, are prescribed by some urologists, but results have not been predictable. Intracavernosal injection pharmacotherapy remains the most effective and safe medical treatment available for patients with neurogenic impotence.