Organic impotence is far more frequent than usually thought. Diagnosed frequently on clinical grounds, organic impotence is confirmed by more sophisticated and invasive techniques (Multi Modal Psychologic interview: MMPI, Nocturnal penile tumescence detection, pelvic angiography). Apart from local and neurogenic factors, vasculogenic impotence seems very frequent although its treatment has not met with the anticipated success. Intracavernous prosthesis remains the best form of palliative treatment in cases of organic impotence.