SPONTANEOUS EJACULATION DURING PELVIC FLOOR THERAPY
A common but rarely discussed question often comes up for men in pelvic floor therapy: what happens if someone experiences a spontaneous ejaculation or unexpected erection during pelvic floor therapy?
For many people, this possibility feels uncomfortable, confusing, or even embarrassing to talk about. But it’s important to understand what is happening in the body, why it occurs, and how pelvic floor therapists approach these situations with professionalism and compassion.
In this blog, I’ll break down the science behind spontaneous ejaculation, explain the role of the nervous system and pelvic floor, and discuss how pelvic floor therapists should respond to these reflexes in a supportive, nonjudgmental way.
Understanding Reflexes Versus Arousal
One of the first things to clarify is that a spontaneous ejaculation or erection during pelvic floor therapy does not mean that a person is sexually aroused or “into it.” These responses are not necessarily driven by erotic thoughts or emotional desire. Instead, they are reflexes of the nervous system.
The erection and ejaculation reflexes live in the spinal cord. The sympathetic nerves involved in ejaculation come from the thoracic spinal levels T11–T12 through the hypogastric nerves. This is the “shoot” part of the familiar “point and shoot” phrase used to describe male sexual reflexes. Erection, on the other hand, is governed by parasympathetic input from the pelvic nerves (S2–S4), including the pudendal nerve, which is the “point.”
When the perineum or internal pelvic floor muscles are stimulated during therapy—whether through an internal exam or manual treatment—these nerve pathways can be activated. For some people, especially those who feel nervous or already have an upregulated nervous system, this can trigger an involuntary reflex.
What Is Arousal Non-Concordance?
This is where the concept of arousal non-concordance comes in. Arousal non-concordance happens when the body’s physical response does not match what someone is feeling mentally or emotionally. In other words, the body may respond with an erection or ejaculation even when there is no sexual arousal, interest, or desire.
Research shows that arousal non-concordance is common across genders. The body may respond in ways that surprise us, and it does not necessarily mean anything about what we want, feel, or are attracted to. It is simply the body doing what it is wired to do when certain nerve pathways are activated.
Understanding this distinction is essential. It helps to remove shame from the experience and makes it clear that these reflexes are normal physiological processes, not a reflection of someone’s intentions or desires.
The Role of Pelvic Nerves and Muscles
Several specific nerves and muscles play key roles in this reflexive process.
The dorsal nerve of the penis or clitoris, a branch of the pudendal nerve, is primarily sensory but also carries some motor function. It runs from the ischial ramus, joins the deep dorsal vein at the base, and travels along the dorsum of the penis or clitoris to the glans. This nerve sends sensory information back to the brain and is critical for both urination and ejaculation. Stimulation of this nerve can, even in a non-sexual medical context, lead to reflexive arousal or ejaculation.
Muscles such as the bulbospongiosus and ischiocavernosus, along with the external urethral sphincter, are also part of this process. These muscles are controlled by the deep branch of the perineal nerve. When they are hypersensitive or have altered feedback loops, they can contribute to unintentional reflexive responses during therapy.
Why This Happens in Therapy
When a therapist performs internal pelvic floor work, it often involves direct or indirect contact with sensitive nerves and muscles. For people who may already feel anxious, the nervous system can be more reactive. Combined, these factors can create the conditions for a reflexive erection or ejaculation.
This does not mean therapy is sexual. Pelvic floor therapy is a medical treatment focused on restoring function, reducing pain, and improving quality of life. The body’s reflexes do not change the purpose of the treatment or the intentions of either patient or therapist.
How Pelvic Floor Therapists Handle These Situations
Professionalism and compassion are at the heart of pelvic floor therapy. Therapists know these reflexes are possible and discuss them openly with patients before beginning any internal treatment. Setting expectations helps normalize the experience and lets patients know that they will not be judged if it happens.
If a spontaneous erection or ejaculation occurs, the therapist’s response is simple and respectful. Typically, the therapist will pause, check in with their patient, step out of the room if needed to give the patient some time to regroup. When treatment resumes, the therapist checks in about comfort and consent before moving forward.
The goal is always to support the patient without shame or assumption. Therapy remains a medical intervention, not a sexual encounter.
Why This Conversation Matters
Silence around sexual reflexes in medical treatment can create shame and confusion. When people believe that a reflexive erection or ejaculation means they are doing something wrong, they may avoid seeking care or stop treatment that could help them.
By talking openly about these reflexes, we can reduce stigma and empower patients to continue their care without fear of judgment. Transparency also helps patients feel safer and more comfortable in therapy, which is essential for progress.
Therapy Is Not Erotic Work
It is important to draw a clear boundary between pelvic floor therapy and erotic practices. Pelvic floor therapy is medical treatment performed by licensed healthcare providers. While some therapists, including myself, may also have training in sexuality counseling, this does not mean that therapy includes intentional erotic or sexual touch.
For people who want to explore arousal, intimacy, or erotic embodiment through experiential touch, there are other professionals who specialize in that work. Surrogate partners, somatic sex educators, and sexological bodyworkers are specifically trained to provide hands-on experiences in those contexts.
Pelvic floor therapy, however, stays within the medical and rehabilitative realm. The role of the therapist is to support the bladder, bowel, sexual organs, pelvic floor, and overall health and function of the “middle parts” through a medical lens, not sexual gratification.
Reducing Shame and Building Trust
For many people, the idea of a spontaneous sexual reflex during therapy feels overwhelming. But when patients understand that these responses are reflexive and not tied to desire, it becomes easier to move through the experience without shame.
Pelvic floor therapists who address these possibilities directly build trust with their patients. By normalizing what the body might do, they create a safer therapeutic environment. Patients can focus on their goals, whether that is pain relief, improved bladder or bowel function, or better sexual health, without worrying about how their body might react during a session.
The Takeaway
Spontaneous ejaculation or unexpected erections during pelvic floor therapy are normal physiological reflexes of the nervous system. They do not mean arousal, attraction, or desire. These responses occur when nerve pathways and pelvic muscles are stimulated, sometimes in combination with heightened nervous system activity.
Pelvic floor therapists handle these situations with professionalism, compassion, and respect. By normalizing and discussing these reflexes openly, therapy can remain a safe, effective, and supportive medical treatment.
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This information is not intended to substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a healthcare professional with any questions you may have regarding treatment, medications/supplements, or any medical diagnoses. This information is intended for educational purposes only and is in no way to substitute the advice of a licensed healthcare professional.
