Autofellatio is described psychoanalytically as a multilevel oral–genital auto-erotic phenomenon manifested by acts, fantasies and dreams, with their associated instinctual drive derivatives and related objects. One female and one male patient are presented. The structuralization of the autofellatio phenomenon is discussed, as well as similarities and differences between male and female patients. Overt anal psychosexual-level material did not appear. Factors are examined which influence the selection of autofellatio rather than fellatio or masturbation.