OBJECTIVE: The relation between chronic alcohol abuse and male sexuality remains uncertain. This study assessed the effect of chronic alcoholism on sexual function, marital adjustment, sleep-related erections, sleep disorders, and hormone levels during abstinence from alcohol. METHOD: Twenty chronically alcoholic men, aged 28-59 years, without evidence of severe hepatic disease and free from unrelated medical illnesses, were assessed 2-36 months after achieving sobriety and compared to a group of 20 nonalcoholic volunteers. Each subject and his sexual partner underwent semistructured interviews and completed several questionnaires; the men had medical and psychiatric evaluations and polygraphic assessment of sleep parameters and nocturnal penile tumescence during 4 nights, with the last night devoted to sequential blood sampling for evaluation of hormone levels. RESULTS: The alcoholic men did not differ from the comparison group in any sexual dimension or in the prevalence of sexual problems despite the significant marital dissatisfaction reported by their sexual partners. In addition, there were no differences between groups in sleep and nocturnal penile tumescence measures. The alcoholic group had a greater prevalence of periodic leg movement disorders but no respiratory abnormalities during sleep. Except for a significant overnight increase in plasma luteinizing hormone in the alcoholic men, there were no differences between groups in total and bioavailable testosterone, dihydrotestosterone, and prolactin or in the nocturnal circadian changes in testosterone and prolactin levels. CONCLUSIONS: These findings suggest that prolonged and severe alcohol abuse in men is compatible with normal sexual function during sobriety in the absence of substantial hepatic or gonadal failure.