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As longevity after spinal cord injury (SCI) has increased, attention has shifted from treatment of active conditions to prevention of secondary disability and enhancement of quality of life. Satisfactory sexual functioning is an important contributor to quality of life. Little attention, however, has been paid to the impact of aging on sexual function after SCI. This article describes the effects of aging on sexual functioning in ablebodied persons and how these effects may influence sexual functioning in men with SCI. Physiological decreases in hormonal concentrations, muscle mass, and bone strength can have a marked effect on individuals who already have deficits in these areas as a result of SCI. Many of the treatments of sexual dysfunction in SCI are relatively new, such as intracorporeal injections and oral sildenafil, and the safety and efficacy of long-term use are not clear. Medical conditions common in the elderly, such as coronary artery disease, cerebrovascular disease, and depression, can have an additive effect on sexual functioning in persons with SCI, and treatment of these conditions may require a change in the management of the SCI-related sexual dysfunction. A satisfactory sex life can be achieved after SCI, but the maintenance of sexual function will require close monitoring and coordination among SCI clinicians and those involved in the treatment of sexual dysfunction. More research is needed on the unique problems associated with sexual functioning in the aging individual with SCI.