3-2-1: Orgasm, Ejaculation, and the Pelvic Floor

I. Visual observation matters
Pelvic floor assessment can start with what you see. Penis lift, testicular rise, anal contraction, and relaxation each tell you something about range of motion and motor control. Sometimes they appear together, sometimes in sequence. Both patterns are clinically meaningful.

II. Contraction strategies vary
Not every patient can isolate different components of the pelvic floor. For some men, awareness stops at the anal sphincter. For others, contraction strategies may even contribute to post-void dribble or pain. Training separation and control can be optimization, not just rehabilitation.

III. Orgasm is not ejaculation
Ejaculation is a reflex. Orgasm is a sensory and motor experience that can exist without fluid release or even erection. Post-prostatectomy men often prove the point. Helping patients separate these concepts reframes treatment from “performance failure” to “pleasure potential.”

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I. Sex therapist Dr. Barry McCarthy on pleasure:
“Good sex is not about performance. It is about connection, satisfaction, and pleasure.”
Shift the focus from what is missing to what can still be felt.

II. Philosopher Alan Watts on awareness:
“Muddy water is best cleared by leaving it alone.”
Sometimes the task is not to fix, but to notice and allow.

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When you teach a patient about orgasm and ejaculation, do you describe them as the same event or as separate systems? How might reframing change their hope for recovery?

With care,

Team IPC