Erectile dysfunction (ED) following treatment for lower limb fractures is not uncommon. The mechanism is thought to be a perineal neurovascular traction injury acquired during surgery. Four young men who sustained femur fracture underwent reduction and intramedullary nail fixation. Post-operatively each presented with varying degrees of ED. Phosphodiesterase inhibitors were used in each case and sexual function returned in all. It is essential that a sexual history be taken in all patients after internal fixation of femur fractures so that treatment can be initiated early on if required. This serious complication from traction may be avoidable with careful patient positioning during traction.