Sexual dissatisfactions are virtually universal among individuals who seek psychotherapy. Sexuality is not simply biology. In addition to physical processes leading to arousal, tumescence, and release, sexuality involves the capacity to trust and feel trustworthy, to merge and separate without intolerable anxiety, and to experience the sexual partner as a consort rather than an incestuous parental substitute. Sexuality, physically and subjectively, flows so smoothly when properly integrated that it seems almost natural, yet it is the product of a long, complicated, and difficult developmental sequence. Hesitation, fright, repugnance, anger, withdrawal, or disappointment infect sexual participation whether or not there is an accompanying incapacity in performance. In fact, the more substantial the ego strengths and the more compensated the neurosis or character disorder, the more likely there are to be failures of satisfaction or impairment of sexual creativity rather than loss of function. (30 pp.)