Thirty-eight spinal cord injured (SCI) males (median age = 26) completed an 80-item multiple choice questionnaire (median 37 months postinjury) which assessed sexual functioning pre- and post-spinal cord injury in four areas: (i) sexual activities and preferences, (ii) sexual abilities, (iii) sexual desire, arousal, and satisfaction, and, (iv) sexual adjustment. Frequency of sexual activity decreased following SCI with a reduction in intercourse and increased interest in alternative sexual activities. Of complete quadriplegic subjects 38% reported the ability to have an orgasm accompanied by ejaculation underscoring the need for physiological studies. Partner's desire for sex as perceived by the SCI individual was correlated with frequency of sex and numbers of sexual partners postinjury. Subject's perceptions of their own and partner's sexual desire decreased following SCI. Sexual satisfaction decreased postinjury and was positively correlated with both the patients' and their partners' interest in penile-vaginal intercourse. Of the subjects, 27% reported sexual adjustment difficulties and 74% relationship difficulties but only 22% received counseling. Results indicate the importance of the availability and desire of a sexual partner in the sexual activities and satisfaction of the SCI individual. SCI patient and staff sexual education and counseling continue to be strong needs.