Moses Laufer described the central masturbation fantasy as an essentially adolescent phenomenon that leads to the final sexual organization. In this paper the central masturbation fantasy, formulated during the preoedipal and oedipal years, consolidated in adolescence, and in a process of continuous evolution across the life cycle, is considered an essential concept for understanding sexuality in heterosexual males. Sex and aggression, as posited in Freud's dual theory of the drives, are core components of all masturbation fantasies, across the diagnostic spectrum, from the most normal/neurotic to the most criminally bizarre. Clinical examples illustrate both points. The tendency among clinicians, particularly clinical associates, to avoid analyzing all aspects of masturbation is discussed.