Manifest references to sex issue from varied levels of psychic function, and they serve many functions in the patient's construction of the here-and-now analytic relationship. Once explored psychoanalytically, with special reference to transference and countertransference, that manifest material often leads into the unconscious fantasies characteristic of the paranoidschizoid position, as described by Kleinian analysts. Resolution of sexual problems then requires working through the primitive narcissistic trends on that level. Clinical examples are included.