Psychoanalytic efforts to think sexual difference beyond the restrictions of binary notions about anatomy and gender continue to prove challenging in both clinical practice and theory building. Claims that such binary notions are no longer applicable fail to take seriously the ongoing power of binary processes as they manifest both consciously and unconsciously. Without a capacity to think sexual difference as more than two, a capacity that resists the lure of spectrum modeling, efforts to conceptualize intersexuality and other nonbinary forms of anatomy and gender falter. An exploration into the challenges faced by two parents of an intersex baby, especially regarding the dilemma of pursuing genital surgery or not, shows some of the difficulties inherent in thinking sexual difference when the profound inadequacy of binary notions cannot be ignored.