Sex & Intimacy Therapy
A thoughtful, confidential space for individuals and couples
In-person sessions in Des Peres | Telehealth throughout Missouri
Sexuality and intimacy are deeply personal parts of being human.
When something feels painful, disconnected, confusing, or difficult to name, it can affect far more than your sexual relationship. It may shape how you experience your body, your partner, your sense of safety, and even yourself.
At Maison Fleur, sex and intimacy therapy offers a steady, respectful space to explore these concerns without judgment or pressure. You do not need the right words or a clearly defined goal. We can begin with what you know—and make room for what is still unfolding.
Reasons You Might Seek Sex Therapy
People seek sex therapy for many reasons. Sometimes the concern is clear.
At other times, something simply feels distant, strained, or no longer like it once did.
Therapy may support individuals and couples experiencing:
Differences in sexual desire
Emotional or physical disconnection
Sexual pain or discomfort
Difficulty with arousal, orgasm, erection, or sexual performance
Anxiety, avoidance, or pressure surrounding sex
Shame or difficulty talking about sexuality
The effects of sexual trauma or unwanted experiences
Body-image concerns or difficulty feeling present in the body
Infidelity, sexual betrayal, or loss of relational trust
Compulsive or addictive sexual behaviors, including pornography concerns
The influence of faith, family, culture, or earlier messages about sexuality
Changes following pregnancy, childbirth, illness, menopause, aging, or other life transitions
Questions about identity, boundaries, needs, or sexual well-being
A desire for greater emotional intimacy, pleasure, or connection
You do not need to debate whether a concern involving sex is “serious enough” for therapy.
Sexual concerns are rarely just about sex—they often touch trust, safety, identity, the body, and how we experience closeness. If something is affecting your well-being, your relationship, or your experience of intimacy, it deserves thoughtful attention.
Sexual Concerns Rarely Exist in Isolation
Intimacy is shaped by more than physical functioning. It is influenced by attachment, trust, communication, stress, health, past experiences, cultural messages, body image, and the emotional patterns within a relationship.
Sexual concerns are not treated here as isolated problems to be corrected. Together, we consider the fuller context: what happens between you and a partner, what happens within you, and what your body may have learned about closeness, vulnerability, safety, or desire.
The goal is not to impose a particular definition of a healthy sexual relationship. Therapy helps you understand your experience, communicate more openly, and move toward intimacy that feels safer, more authentic, and mutually meaningful.
Sex Therapy for Couples
When partners experience different levels of desire, repeated rejection, avoidance, pain, betrayal, or difficulty communicating about sex, the concern can become part of a painful relational cycle.
One partner may feel unwanted, lonely, or anxious about initiating. The other may feel pressured, inadequate, misunderstood, or responsible for preserving the relationship through physical intimacy. Over time, both partners may become increasingly guarded—even when each is longing for closeness.
Couples sex therapy creates room to slow that cycle down.
Together, we may work to:
Understand the emotional and relational patterns surrounding intimacy
Communicate about sex with greater clarity and less defensiveness
Reduce pressure, shame, blame, or avoidance
Rebuild emotional and physical safety
Navigate differences in desire, preferences, or expectations
Repair trust following infidelity or sexual betrayal
Develop a more collaborative and mutually respectful intimate relationship
Rediscover forms of connection that have become difficult to access
The work is not about deciding which partner is right.
It is about understanding what has developed between you and creating a steadier way forward.
Sex Therapy for Individuals
You do not need to be in a relationship to benefit from sex therapy.
Individual work may provide room to understand how past experiences, attachment, shame, anxiety, faith, body image, trauma, or relationship history have shaped your experience of intimacy and sexuality.
Therapy may help you:
Better understand your needs, boundaries, and patterns
Feel more connected to and at ease within your body
Work through shame, fear, confusion, or avoidance
Process the effects of sexual trauma or unwanted experiences
Explore compulsive or addictive sexual behaviors without reducing you to a behavior
Communicate more confidently within present or future relationships
Integrate sexuality with your identity, values, or faith in a way that feels authentic
Build a more compassionate relationship with yourself
The pace is shaped collaboratively, with attention to consent, emotional safety, and what you feel ready to explore.
What Sex Therapy Is Like at Maison Fleur
Sex therapy is a specialized form of talk therapy. Sessions do not involve sexual contact, nudity, physical examination, or sexual activity—between partners or with the therapist.
Sessions may include conversation, reflection, education, communication work, or thoughtfully selected exercises to complete privately outside of therapy. Any suggestion is discussed collaboratively, and you remain in control of what you choose to explore.
You will never be required to disclose intimate details simply for the sake of disclosure. We begin where you are, use language that feels manageable, and move at a pace that respects both vulnerability and safety.
Therapy at Maison Fleur is attachment-informed, trauma-aware, and relational. The work balances emotional depth with practical support, helping you understand the patterns beneath a concern while creating meaningful movement in your life and relationships.
Specialized, Respectful Care
Lily Pernoud is a Licensed Professional Counselor and Certified Sex Therapist with advanced training in intimacy, sexuality, attachment, relational trauma, eating disorders, body image, and embodiment.
Her approach is professional, collaborative, and grounded in respect for each person’s values, identity, boundaries, relationships, and lived experience.
Sexual concerns can involve overlapping emotional, relational, and physical factors. When medical, psychiatric, pelvic-health, or other specialized support may be helpful, therapy can complement the work of other healthcare professionals. Coordination may occur with your written permission when appropriate.
Frequently Asked Questions
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Sex therapy is talk therapy focused on concerns related to sexuality, intimacy, sexual functioning, embodiment, and relational connection. It may include emotional exploration, education, communication support, and strategies tailored to the individual or couple.
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No. Sex therapy is available to individuals and couples. Individual therapy can address personal concerns, past experiences, shame, identity, boundaries, compulsive behaviors, or patterns affecting present or future relationships.
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No. You do not need to have achieved abstinence or have everything under control before beginning therapy. Readiness and meaningful change often develop through the therapeutic process.
Together, we can work to understand the patterns, emotions, triggers, and unmet needs connected to the behavior while strengthening accountability, safety, and your capacity to make more intentional choices. When additional recovery support or a higher level of care would be helpful, appropriate recommendations can be discussed collaboratively.
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Only to the degree that it is clinically useful and feels appropriate. You may be invited to describe relevant experiences, patterns, or concerns, but you will not be pressured to share unnecessary details.
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No. Sex therapy is a form of talk therapy. Sexual contact, nudity, physical examination, and sexual activity—between partners or with the therapist—are not part of sessions.
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You do not need to determine that before reaching out. Sexual concerns often involve overlapping physical, emotional, and relational factors. Therapy can help clarify what may be contributing and, when appropriate, support collaboration with a physician, pelvic-floor therapist, or another healthcare professional.
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Yes. Faith and spirituality can be included when they are meaningful to you. Therapy can provide room to explore how beliefs, values, religious messages, shame, and personal experience intersect with sexuality and intimate relationships.
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It is common for partners to begin with different levels of comfort, hope, or readiness. Those differences can be acknowledged and explored without forcing either partner into premature agreement.
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Couples and relationship therapy is offered on a private-pay basis. Insurance coverage may be available for individual therapy depending on plan participation, clinical needs, and benefits.
Additional information is available on the Fees & Practice Policies page.
A Steadier Way Into Intimacy
Conversations about sex and intimacy can feel vulnerable to begin. You do not need certainty, perfect language, or agreement about exactly what needs to change.
Only a willingness to begin.
Maison Fleur offers confidential, thoughtfully tailored therapy for adults and couples—with in-person sessions in Des Peres, West St. Louis County, and telehealth throughout Missouri.