Multiple sclerosis (MS) is a devastating neurologic disease that attacks young adults and affects all aspects of their lives. Genitourinary dysfunction in MS has a significant impact on quality of life with more than 80% of those with MS reporting genitourinary symptoms. Voiding dysfunction is a prominent problem affecting the majority of MS sufferers. Less commonly recognized, but of no less importance, is sexual dysfunction which affects both men and women with MS. At least 75% of men and 50% of women report sexual dysfunction and suspicions of under-reporting are strong. In this review, physiology of micturition, sexual functioning and disruptions in neural pathways occurring in MS that can result in the clinical syndromes of voiding dysfunction, sexual dysfunction and paraphilias will be discussed. Management of these disorders is also reviewed.