Summary  Smooth muscle relaxation of penile arteries, the corpus cavernosum, and the corpus spongiosum, leading to penile erection, results from parasympathetic neural pathway activation and, likely, simultaneous inhibition of sympathetic outflow. Proerectile parasympathetic outflow is reflexively activated by sensory information of peripheral origin, conveyed by the dorsal penile nerve, and reflexive erections are supported by an intraspinal circuitry. Supraspinal influences modulate the reflex. Information integrated at or originating from supraspinal structures may also elicit penile erection. Several neurotransmitters are involved in either the modulation of the spinal reflex or the mediation of supraspinal influences. Spinal cord injury differently alters reflexive penile erection or erection from a central origin, depending on the neurologic level of injury.