This chapter provides an introduction to approaches in sexuality counseling. It presents an overview of male and female physiology. The prostate gland is a partly muscular and partly glandular male sex gland whose major function is to secrete a slightly alkaline fluid forming part of the seminal fluid. Seminal vesicles, sac-like glands that lie behind the bladder, release fluid for transport of sperm. Spermatogenesis begins with a pulsatile hypothalamic release of gonadotrophin releasing hormone (GnRH) that induces the release of pituitary luteinizing hormone (LH) and follicle stimulating hormone (FSH). Female sexual responses require transmission of somatic, afferent, parasympathetic, and sympathetic signals. The chapter describes the common neurologic disorders and their impact on sexuality and reviews treatment options for those disorder. Sexual activity for men with spinal cord injury (SCI) or multiple sclerosis (MS) is possible. The anticholinergic and sympatholytic effects of psychoactive drugs impair sexual function.