Few studies have thoroughly investigated the incidence and detailed the degree of sexual disability after aortic aneurysm surgery. Reports prior to 1990 vary greatly in the incidence of postoperative dysfunction mostly because of nonstandardized methods of assessment. In this article, we compare the incidence of reported sexual dysfunction after aortic reconstruction, open and endovascular abdominal aortic aneurysm repair. Pertinent studies on sexual dysfunction following open and endovascular aortic aneurysm repair were identified from a MEDLINE search of English-language publications since 1966. Newer standardized methods of assessment have identified relatively high rates of sexual dysfunction prior to and after intervention. Aortic aneurysm patients have a baseline incidence of sexual dysfunction of approximately 30%, which doubles over the next 7 years. Patients who had open aortic operations reported significantly increased sexual dysfunction during the first postoperative year. Endovascular repair with unilateral internal iliac occlusion results in new sexual dysfunction in approximately 10% of patients, but this increases significantly with bilateral internal iliac occlusion. When compared with open operation, the incidence of sexual dysfunction is lower overall in patients with endovascular aortic aneurysm repairs, which includes those who have internal iliac artery occlusion, but it is increased with bilateral iliac occlusion. Surgeons should be aware of the preoperative prevalence of sexual dysfunction in patients undergoing aortic procedures.