Sexual dysfunction after stroke is a frequent occurrence impacting on the quality of life of the affected patients. Altered sexual activity after stroke is believed to depend upon impairment of brain areas controlling libido and sexual behavior. Co-morbidity and general health status together with psychological factors are important determinants of post stroke sexual functions. More recently, a role for CNS-driven autonomic system dysfunction at the level of male reproductive tract has also been recognized in animal models. This new information may offer novel open interpretations and treatment perspectives of this condition, at least in a portion of the patients.