As our understanding of the basic mechanisms of erectile function continues to grow, new therapies will emerge in the treatment of erectile dysfunction with the eventual goal of eliminating the need for surgical treatment of the disease. We have witnessed a dramatic change in the treatment of men with erectile dysfunction. Treatment options have progressed from psychosexual therapy and penile prostheses in the seventies, through arterial revascularization, vacuum constriction devices, and intracavernous injection therapy in the eighties, to transurethral and oral drug therapy in the nineties and perhaps gene or growth factor therapy in the new millennium. Gene therapy may begin to define a place in the urologist's armamentarium, in order to help restore corporal, neural, vascular and tunical tissues in the penis to their normal state.