The increasing emphasis on surgical, pharmacological, and mechanical solutions to erectile failure in the past decade has led to a relative neglect of the importance of couples dynamics in both the genesis and maintenance of erectile failure. Yet ignoring such issues compromises the success of sex therapy. Systemic approaches, family-of-origin issues, transferential projections, and cognitive-behavioral interventions may all have a place in treatment. These conceptual approaches are reviewed and four key relationship variables, namely, status and dominance, sexual attraction and sexual "chemistry," intimacy and trust, and sexual scripts, are highlighted as being of special importance in the evaluation and treatment of erectile problems.