The organization of virtually all basic survival mechanisms in the central nervous system (CNS) is within the most central regions of the mesencephalon and the rostrally adjoining diencephalon; in particular, the mesencephalic periaqueductal gray (PAG) and hypothalamus. The PAG sends specific pathways to the caudal brainstem where neurons are located that, in turn, control nociception, blood pressure, heart rate, and micturition. Via projections to the nucleus retroambiguus (NRA) in the most caudal part of the medulla, the PAG controls the intra-abdominal pressure associated with vocalization, vomiting, and parturition. In cats, the PAG also controls sexual posture via NRA projections to motoneurons in the lumbosacral cord. These NRA-lumbosacral motoneuronal pathways are almost nine times stronger in the estrous vs. non-estrous female cat. While neuronal activity in specific CNS pathways is now known to control sexual behavior in the cat, how is it organized in the human? PET-scan results on human ejaculation have revealed that the meso-diencephalic transition zone is particularly and strongly activated. This region includes the so-called ventral tegmental area that is also known as a "reward area." For example, it is also activated during a heroin rush. Other strongly activated structures during sexual activity include the cerebellum and lateral part of the corpus striatum. At the level of the cerebral cortex, areas in the prefrontal and parietal cortex are also activated, but exclusively on the right side. Further study of these structures should certainly lead to better insight into human sexual behavior and provide the possibility to improve sexual activity in those who suffer from problems in this area.