This chapter discusses the role of the cortical and subcortical areas in the control of pelvic organs. It presents case histories, the lesion literature, effects of injury or disease at focal sites. The results of diffuse cortical and subcortical diseases are then considered. The temporal lobes have little or no apparent influence on bladder or bowel control but a major role in determining sexual behavior. Cerebrovascular disease is often accompanied by bladder dysfunction. The severity, extent and site of brain damage following brain injury are so variable that generalizations about the effect of traumatic brain injury on pelvic organ dysfunction are impossible. Recommendations have been made to treat specific aspects of sexual dysfunction following traumatic brain injury. An expected correlation is seen between the occurrence of a neurogenic bladder and the severity and extent of brain damage so that urodynamic abnormalities have been associated with motor deficits.