Delayed Ejaculation in Men: Could Pelvic Floor Muscle Control Be Part of the Problem?
Delayed ejaculation can be frustrating, especially when a man is able to become aroused and maintain an erection but has difficulty reaching orgasm or ejaculation during sexual activity.
There are many possible reasons for delayed ejaculation, including medications, hormonal changes, neurologic conditions, psychological factors, changes in sensation, and certain medical conditions. For some men, however, pelvic floor muscle function may also play a role.
Your pelvic floor muscles are involved in ejaculation
The pelvic floor is a group of muscles located at the base of the pelvis. These muscles contribute to urinary and bowel control, erection, and the process of ejaculation.
During ejaculation, the pelvic floor muscles participate in rhythmic contractions that help propel semen through the urethra. This means that having good pelvic floor function involves more than simply having strong muscles.
The muscles also need to be able to:
Contract when appropriate
Relax when appropriate
Coordinate with the abdominal and respiratory muscles
Produce repeated contractions
Respond to changes in sensation and arousal
When a man has difficulty coordinating these muscles, sexual function can sometimes be affected.
It is not always about having a weak pelvic floor
One common misconception is that pelvic floor problems automatically mean the muscles are weak.
In reality, some men have difficulty relaxing an overly tense pelvic floor, while others may have difficulty generating or coordinating an effective contraction. Some men have a combination of both.
For example, a man may be able to perform a strong pelvic floor contraction but have difficulty releasing that contraction fully. Another man may have difficulty identifying the muscles or coordinating them without compensating with the abdomen, buttocks, or other muscles.
Research on pelvic floor rehabilitation has primarily focused on other male sexual dysfunctions, particularly premature ejaculation, but it demonstrates that pelvic floor rehabilitation can address muscle coordination, strength, endurance, and control.
What does “poor muscle control” actually mean?
Pelvic floor muscle control is your ability to use the right muscles at the right time and then allow them to relax.
A pelvic floor physical therapist can assess whether the muscles are:
Weak or lacking endurance
Overactive or tense
Difficult to relax
Difficult to isolate
Poorly coordinated with breathing and other muscles
Being recruited with excessive tension in the abdomen, glutes, or thighs
This assessment is important because simply doing more Kegels is not necessarily the right treatment.
In fact, the Urology Care Foundation notes that men can unintentionally recruit other muscles when trying to exercise the pelvic floor, which can interfere with learning proper muscle activation.
How can pelvic floor physical therapy help?
Treatment depends on what is found during the evaluation.
Your physical therapist may work on improving your awareness of the pelvic floor, learning how to contract and relax the muscles, improving coordination and endurance, and reducing unnecessary muscle tension.
Treatment may include:
Pelvic floor muscle retraining
Relaxation and down-training
Breathing and pelvic floor coordination
Biofeedback
Manual therapy when appropriate
Strength and endurance training when indicated
Coordination of the pelvic floor with surrounding muscles
The goal is not simply to make the pelvic floor stronger. The goal is to help you develop better control and coordination of the muscles involved in pelvic function.
When should you talk to your doctor?
Delayed ejaculation can have causes outside of the pelvic floor. Certain medications, including some antidepressants, neurologic conditions, hormonal changes, alcohol use, and psychological or relationship factors can contribute.
If delayed ejaculation is new, persistent, or causing distress, discussing it with your physician or urologist is important. A pelvic floor physical therapy evaluation may be appropriate when pelvic floor dysfunction is suspected or when other pelvic symptoms are also present.
You don't have to just live with it
Sexual function is an important part of men's health, but concerns such as delayed ejaculation are not always openly discussed.
If you are able to become aroused and maintain an erection but consistently have difficulty reaching ejaculation, pelvic floor muscle function may be one area worth evaluating.
A pelvic floor physical therapist can assess how well your pelvic floor muscles contract, relax, and coordinate with the rest of your body and develop an individualized treatment plan based on those findings.
If you are experiencing sexual dysfunction or other pelvic health concerns, reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com to determine whether pelvic floor dysfunction may be contributing to your symptoms.