Men with spinal cord injuries often suffer from erectile dysfunction, ejaculatory dysfunction, infertility and hypogonadism. However, efficient and safe treatments exist as summarised in this review. Erectile dysfunction can be treated step by step with phosphodiesterase 5 inhibitors, intracavernous injections and penile implant surgery. Ejaculatory dysfunction can in almost all cases be treated by using penile vibratory stimulation and electroejaculation. Surgical sperm retrieval can be used as a last resort. These patients have a high prevalence of hypogonadism, and testosterone replacement therapy can be used to alleviate symptoms of low testosterone levels.