INTRODUCTION: Honeymoon impotence can be defined as the failure to be successfully involved in sexual intercourse at the beginning of marriage, particularly in the first few nights. While its exact causes are not yet elucidated, many studies recognize this problem as related to performance anxiety. AIM: The aim of this study was to report the outcome of management of patients with honeymoon impotence. METHODS AND MAIN OUTCOME MEASURES: This study included 100 consecutive patients presenting to our department complaining of failed sexual intercourse since the beginning of their marriage. History taking, completion of the abridged form of the International Index of Erectile Function (IIEF-5) questionnaire, and combined intracavernous injection and stimulation and nocturnal penile tumescence monitoring were performed. Penile duplex was performed to elucidate vascular insufficiency. All psychogenic patients with erectile dysfunction (ED) were treated with sildenafil and sex therapy. All organic ED patients were treated either with sildenafil alone or combined therapy with either intracavernous prostaglandin E1 or vacuum constriction device. RESULTS: Seventy-four patients had psychogenic ED and 26 patients had vasculogenic ED. All psychogenic ED patients were treated successfully with sildenafil and sex therapy. Twenty-two patients with vasculogenic ED were treated successfully with sildenafil or combined therapy, while four patients needed venous surgery. Minimal side effects of all treatment modalities occurred throughout the study. CONCLUSIONS: Management of honeymoon impotence requires profound diagnosis of its causative factors. Treating physicians in areas with high prevalence of this condition should be ready to manage this problem with vigilant systematic overture. A combined approach of sildenafil and sex therapy proved highly effective in treatment of honeymoon impotence of psychogenic origin; however, controlled studies are needed. Other patients showing functional erectile abnormalities should be treated accordingly.