Social representations of sexuality and gender have profoundly changed since Freud, and even more intensely in recent decades. But what about the clinical experience of the psychoanalyst today, and what theoretical consequences can we draw from it? After having gone over the classic psychoanalytic conceptions of psychic bisexuality and underlined that a certain identification always takes place before the assumption and decision of the gendered self, some clinical cases will allow us to highlight various nuances in the experience of the gender, as well as the persistence of anxieties and a certain destiny of fantasy within gender identifications. The most original element of human sexuality may still have its roots in fantasy, and the most sexual sex might always be that which this fantasy imagines.