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Sex & Gender Therapy in St. Louis

Creating space to help you feel at ease with your sexuality, gender identity and body.

Ready to end stress around sex and sexuality?


Sexuality can be a major part of the way we express ourselves, experience life, connect with others, bond, and further intimate relationships. For many of us, our sexuality is a big piece of our identity. It also plays a role in the health of our relationships both with others and with ourselves. 


The problem is that sex, sexuality, sexual trauma, and shame can also be a major source of emotional pain and disconnection. There are many valid reasons why that might be the case. For example, you may feel discriminated against because of your sexual orientation or gender expression. You may be dealing with sexual trauma from your past. You could be having trouble with body dysphoria, societal messaging around sex, low desire, addiction, performance anxiety, an STI diagnosis, trouble communicating needs and boundaries, or a physical symptom related to sexual activity. These struggles, if not addressed, can lead to depression, anxiety, low self-worth, relationship problems, unhealthy relationships, a general unhappiness or sexual avoidance. It’s not all doom and gloom though. Experiences like these are much more common than you may think and most sexual journeys go through ups and downs. That’s why we’re here to support and facilitate healing in this area of your life. Sex can be something that actually brings joy.

Inner turmoil over sexuality can negatively impact your overall wellbeing. 

You didn’t choose this for yourself and you’re sick of feeling...

  • Ashamed of a traumatic incident that occurred at some point during your life. 

  • Confused by sexual orientation, gender dysphoria or personal expression.

  • Overwhelmed with societal standards, shoulds, and mixed messaging. 

  • Anxious about sexual performance or experience level. 

  • Unsure of how to navigate areas of sexuality like BDSM or kink.

  • Angry because societal messaging and discrimination has hindered your ability to enjoy your life as a sexual being. 

  • Hopeless because of changes in physical responses, sex postpartum, or levels of sexual desire.

  • Self-critical of your body, perceived sexual ability, bodily functions or anything else related to your sex life. 

  • Disconnected from a part of life that you thought was supposed to be fun.

  • Skeptical about whether or not it’s possible to lead a fulfilling life after an STI diagnosis.

  • Drained because all of this is taking up way too much mental space every day.


For many, sexuality can feel complicated… but it doesn’t have to. The confusion, isolation, anxiety, and fear you may feel makes sense though when we consider all the ways that we, as a society, are programmed, shamed, discriminated against, or misinformed. (And yes, we’ll help you dismantle all of that.) On top of that, you may have experienced abuse, trauma (sexual or otherwise), the breaking of trust, or ridicule. In these circumstances, it can be tough to experience sexuality in a positive way. That impacts our ability to form healthy relationships—physical and emotional—with ourselves and others. It’s not uncommon for folks to struggle with loneliness, fear of intimacy, or sexual anxiety when this is their experience. It may feel that sex was supposed to bring excitement and happiness but all it’s really bringing is anxiety and despair. 


And sure, sex can help us connect, express ourselves, deepen relationships, explore, and destress but that can only happen once past wounds are healed and harmful narratives are done away with. That’s where we come in.

Wink Portrait


At Healing Exchange, no sex-related concern is too small or too “out there” to bring to therapy. If it’s related to your body, gender, sexual past or sexuality, we’ll help you work through it in a space that’s non-judgemental and honors your experience. As sex therapists, part of our mission lies in delivering care that validates the varied identities and life journeys of our clients. 

Depending on your specific journey, sessions could include examinations of thought patterns or mental habits, different relationship structures (monogamy, open relationships, polyamory, etc.), gender affirming exercises, guidance on sex after trauma, or support in leading a healthy life after an STI diagnosis. We also know that past traumas (including those without a sexual context) can impact sexuality so expect sessions to explore your personal history in a way that’s delicate and tactful.


All Healing Exchange sex therapists understand the ways that day-to-day discrimination negatively impacts a person’s ability to feel secure and at ease in their body. We know that mental health and sexuality are strongly linked. That’s why being on the receiving end of homophobia, racism, sexism, sex-negative attitudes, fatphobia, ableism, effects of colonialism, and other displays of discrimination will impact you as a sexual being. Everyone deserves to be seen, empowered, and valued which is the reason why we approach all sessions from an anti-oppressive framework.

Sometimes we meet with people who are unsure about if or when to try sex therapy. You might be asking yourself if this is for you and if a sex therapist can help with your specific issues. You might want to consider reaching out if you… 


  • Have experienced a sexual trauma like abuse or rape.

  • Have experienced any kind of trauma like an accident, death of a loved one, violence, abuse, or an unstable living environment. 

  • Are dealing with sex or porn addiction. 

  • Are working through questions around gender identity. 

  • Have gone through gender-affirming surgery and need support on your journey. 

  • Need guidance around sexual orientation.

  • Are struggling with issues around purity culture, sex negativity, body shame or sexual shame. 

  • Have concerns about orgasms, painful sex, premature ejaculation, erectile dysfunction, or changes in sexual desire. 

  • Are navigating sexual boundaries being crossed. 

  • Are processing an STI diagnosis. 

  • Are dealing with issues around sex postpartum. 

  • Are looking to facilitate healing or exploration through BDSM or kink.

Black person holding leather flogger and red feather.

Eye Movement Desensitization and Reprocessing (EMDR)

Sex Therapy & Education

Internal Family Systems Therapy (IFS)​

Cognitive Behavioral Therapy (CBT)


​Somatic Experiencing (SE)

Clinicians Specializing in Sex & Gender Therapy

Rafaella Smith-Fiallo, level 3 gottman therapist

Rafaella Smith-Fiallo (she/ella)

LCSW, Certified Sexuality Educator

Rafaella specializes in helping people understand how their history shows up in present relationships. She is attachment oriented and teaches clients that regardless of their 'attachment response' they are deserving of stability and security. She works with all relationship types, from friends to polyamorous triads, with the goal of fostering connection and intimacy that feels nurturing to everyone involved. Learn more about Rafaella.

Rafaella's specific areas of focus include:

  • Helping individuals identify and better navigate the cycles of trauma that keep them in a loop of defensiveness, withdrawing, shutting down, and anxious pursual.

  • Fostering a sense of empathy that leads to stronger relationship accountability and emotional ownership.

  • Creating a culture of vulnerability and transparency that soothes self-doubt and aligns with their goals of having a healthy relationship.

  • Challenging societal standards and 'rules' that just don't work in your relationship so that you can form relationship tenets that actually work for you.

  • Develop intentional relationship rituals that affirm the commitment that all parties have to strengthen the relationship.

Melony Crayton, prepare/enrich and relationship therapist in St. Louis

Melony Crayton (she/her)


Melony takes a sex-positive, body-centered, and sex therapy and trauma-informed approach in supporting client’s in exploring, experiencing, and embracing pleasure with themselves and in their intimate relationships. Melony encourages curiosity and implements somatic practices in her therapeutic approach as a catalyst for sexual exploration, liberation, and healing. Learn more about Melony.

Melony’s specific areas of focus include:

  • Supporting all partnerships in exploring sexual fantasies, desires, and concerns while preserving the health and safety of their relationships.

  • Challenging social and cultural norms that limit your sexual and gender expression so that you can embrace your authentic self.

  • Supporting sexual trauma survivors in restoring safety, trust, and connection with their bodies and reclamation of their sexual self while fostering self-compassion.

  • Creating a supportive and non-judgmental space that affirms sexual and gender exploration and curiosities that cultivates self-intimacy and empowerment.

Eric Jones, sex and gender therapist intern in St. Louis

Eric Jones (he/they)

Sex and Gender Therapist Intern

Eric takes a sex-positive, pleasure-centered, and trauma-informed approach to sex therapy. He is dedicated to working with you to move beyond the limiting beliefs we hold around sexuality and gender in the hopes of accessing the pleasure you deserve to experience. Eric's focus is on assisting you along your process of becoming the empowered person you were always meant to be. Alongside this, they will assist you in navigating sexual issues you might be experiencing, develop the skills to have a fuller sexuality, and decide for yourself how you choose to identify and express yourself in this world. This is all in effort to help you achieve your desired sexuality goals and feeling more gender euphoria. Learn more about Eric.

Eric's specific areas of focus include:

  • Working with clients who are struggling to have the sex life they want, either due to physiological, psychological, or traumatic issues.

  • Working with clients interested in navigating their gender identity and the complex feelings that arise to living a more authentic life.

  • Assisting clients in getting back to a sense of pleasure, developing the necessary skills to experience your sexuality on your terms.


Kat Seal (they/she/any)


Kat’s therapeutic approach is pleasure-centered, trauma-informed, and sex positive. They work with individuals and relationships (of all structures) to build deeper understanding and to develop practices for tapping into authentic expressions of sexuality and gender. Kat assists clients in slowing down, tuning in, and listening to the subtlety and wisdom of their bodies. Drawing attention to somatic cues can be integral in identifying and accessing pleasure, as well as the parts of ourselves that are asking for healing. Gentleness, curiosity, and humor will be your allies on this journey of self-discovery and connectedness. Learn more about Kat.

Kat's specific areas of focus within relationship therapy include:

  • Assisting clients in healing from sex and gender wounding perpetuated by limiting societal norms and scripts, trauma, or previous relationships. 

  • Helping you define what pleasure means to you, and how to incorporate more of it into your life and relationships. 

  • Supporting you in uncovering and affirming parts of true gender expression that help you move from gender dysphoria to sustained gender euphoria. 

  • Connecting to the erotic through rituals for self-love and connection. We’ll implement somatic practices for feeling alive and present in your body, gender, and sexuality.


How do I know if my struggles are worth addressing with a sex therapist? 

If there’s a struggle or problem that is affecting your sex life, sense of self, or intimate relationships, then it’s valid. Sex therapists have heard it all. No issue is too small, too “out there” or not worthy of a discussion. If it’s having an impact, we can help you get to the bottom of it. Remember that most sex therapists hear a broad range of sex-related concerns. Many clients think they are the only one experiencing their particular issue but we can assure you that’s not the case. 


What types of topics is a sex therapist trained in treating? 

Sex therapy covers a very broad spectrum. We deal with everything related to identity issues, being in the LGBTQ+ community, exploring new relationship dynamics, trauma, concerns around physical symptoms like sexual pain or erections, sex postpartum, sex after trauma, STI diagnosis, general sex education, sexual shame, performance anxiety, fear of sex, correcting patterns around intimacy or risk behavior, infidelity, and more. We are sex-positive, body-positive and work in an anti-oppressive framework. 


What if sex feels off, anxiety-inducing or bad but I don’t exactly know why? 

That might be why you need to work with a sex therapist! Sometimes we aren’t aware of the root of our own issues because we are looking in the wrong place or we don’t have the education or context to make relevant connections. Sex therapists spend their whole training understanding how things like trauma, discrimination, toxic relationships, societal expectations, self-esteem and perfectionism could have an impact on other areas of your life like your sexuality. We’ve spent our entire careers understanding connections like this and finding the tools that work so that you don’t have to trial-and-error for years of your life before finding peace.

I’ve never gone to therapy. What can I expect from my first session?

You can expect a professional, supportive and informative conversation with someone who is invested in your journey. We listen with open minds and zero judgment. You lead the way! Tell us why you’re here, what you want to get out of therapy, what success would look like for you, and let us know your boundaries. During the first session we want to know not only where you’ve been but where you want to go so that we can support you on your way to getting there.


How do I know that sex therapy will work? 

It never hurts to talk to a professional. We have the background, skills, education, and training to help those who are suffering due to a sex-related concern or trauma. We also have accurate, up-to-date information regarding many facets related to sexuality and we listen and hold space without the bias that others may have. Because of our background, we’re able to address delicate situations without fear of re-traumatizing clients. 


What if I’m not ready to address a specific trauma from my past?

You control your experience when you come to therapy. That includes setting boundaries and being clear about which topics you’re not comfortable with. You are allowed to decline to answer certain questions or suggest revisiting a topic during a future session. Any boundaries that you set or concerns that you have will be met with grace, kindness and compassion. You’re in charge of your own healing journey and your therapist is there to support you and facilitate that.

So, I don’t think I need therapy. Do you offer sex and gender identity coaching?

Yes, we also offer coaching services when therapy is not the best tool for your process. Read more about the difference between therapy and coaching here and learn about coaching here.

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