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Erectile dysfunction has multiple causes; most commonly the causes are mixed, a combination of physical and physiologic dysfunction. Two hypothetical case presentations provide the context for a discussion of the neurologic basis of erectile dysfunction and sexual dysfunction from the perspective of osteopathic medicine's holistic approach. Both offer osteopathic physicians the challenge of correcting structural, biological, and chemical defects to restore normal function. One of the cases is representative of patients who do not tell their physicians about sexual dysfunction unless their physicians specifically ask, and even then, these patients are most likely to lie to protect their self-esteem. The second hypothetical patient is representative of those patients who consult their physicians for any reason other than sexual dysfunction, expecting their physicians to figure out the real problem. Both of the hypothetical patients require not only support, but also education and counseling to motivate them to adopt healthier lifestyles and choices. Both would benefit from osteopathic manipulative treatment to correct structural abnormalities, and an oral medication such as a phosphodiesterase type 5 inhibitor offers both patients a good and easily accepted treatment option for erectile dysfunction.