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Contrary to trends that deprioritize the role of sexuality in psychoanalysis, this paper contends that sexuality plays an essential and often transformative role in psychoanalytic treatments of neurosis. Following John Forrester’s imperative to “think in cases,” the paper provides a montage of a case of urethral eroticism. The case discussion foregrounds a highly impactful moment within the treatment (concerning the construction of repressed sexual fantasy) and highlights the roles of several crucial psychoanalytic concepts (drive, symptom, fixation, fantasy). A benefit of such detailed clinical material pertaining to sexuality is that it highlights the psychical complexity of any drive impulse. This case discussion demonstrates how a given drive impulse is woven into multiple psychical functions, playing its part in imaginary identifications, in establishing a relation to the Other, in anchoring fantasy, and in an Oedipal manner. While it is true that reductive conceptualizations (oral, anal character types, etc.) have emerged from the history of psychoanalysis, it is nonetheless also true that psychoanalysis should be credited for drawing our attention to the philosophical dignity of any “base” bodily function. In contrast to commonplace notions of sexuality as a conscious project—or identity—psychoanalysis reminds us that there is another form of sexuality, one that exceeds the grasp of our conscious self-understandings.