3-2-1: What the Body Reveals

I. The exam starts when he walks in
Before a word is spoken, you are already gathering data.
Does he move with tension or ease?
Is his posture rigid or collapsed?
Does he scan the room or settle in comfortably?
These simple cues reveal his autonomic tone, postural habits, and pelvic mobility.
You are not just screening his history. You are screening his nervous system in real time.

II. Morning erections and back pain can reveal a treatable ED pattern
When a man reports both, your clinical reasoning sharpens.
Ask these three:
Are morning erections intact?
Does pain change with position or movement?
Does masturbation change the pattern?
The answers help you decide whether to test the spine or refer.

III. Edging for hours but feeling nothing
A 30-year-old patient masturbated for 1 to 2 hours at a time, trying to “last longer.”
He struggled to get erect and felt disconnected from sensation.
Using a simple 1 to 10 arousal scale, he realized he never got past a 3.
Reframing his goal from performance to pleasure gave him a new starting point.
Sometimes clarity begins with asking, what do you actually feel?

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I. On where healing begins
“You do not rise to the level of your goals. You fall to the level of your systems.”
— James Clear
(When patients chase performance without changing their habits, systems, or self-awareness, they stay stuck. Help them build the system).

II. On the link between safety and pleasure
“Pleasure is not a reward. It is the natural response to feeling safe.”
— Hilary McBride, psychologist
(Most men with ED are not failing from lack of effort. They are bracing, over-performing, and disconnected from sensation. Restoring safety in the body can unlock arousal. That is where real change begins).

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How do you help patients shift from “Am I performing?” to “Am I feeling?”

With care,

Team IPC