Premature Ejaculation vs. Delayed Ejaculation: What’s the Difference and What Can You Do About It?

Sexual function can be affected by many different factors, including the pelvic floor muscles. Two common concerns that can affect ejaculation are premature ejaculation (PE) and delayed ejaculation (DE).

While they may seem like opposite problems, both can be frustrating and can affect confidence, intimacy, and sexual satisfaction. The good news is that both are treatable, and pelvic floor physical therapy may be one part of a comprehensive treatment plan.

What Is Premature Ejaculation?

Premature ejaculation occurs when ejaculation happens sooner than desired and a person has difficulty delaying it.

The International Society for Sexual Medicine generally defines lifelong premature ejaculation as ejaculation that occurs within about one minute of penetration, along with an inability to delay ejaculation and associated personal distress. Acquired premature ejaculation can develop after a period of previously typical sexual function.

It is important to remember that occasionally ejaculating sooner than expected does not necessarily mean you have premature ejaculation. PE becomes a concern when it happens consistently and causes distress or difficulty with sexual intimacy.

What can contribute to premature ejaculation?

There isn't one single cause. Premature ejaculation can involve a combination of:

• Pelvic floor muscle weakness or poor coordination

• Increased pelvic floor muscle tension

• Anxiety or performance pressure

• Stress

• Erectile dysfunction

• Relationship factors

• Hormonal or neurological factors

• Prostate or urethral inflammation

• Previous sexual experiences

Because multiple factors can contribute, treatment should be individualized rather than focusing on one muscle or one exercise.

What Is Delayed Ejaculation?

Delayed ejaculation occurs when ejaculation takes significantly longer than desired or does not occur at all.

There is no single amount of time that automatically defines delayed ejaculation. Some men may require a very long period of stimulation to reach orgasm, while others may be unable to ejaculate during partnered sexual activity. The problem is generally considered clinically significant when it is persistent and causes distress.

Delayed ejaculation may be lifelong or acquired, and it may be situational or generalized. For example, someone may be able to ejaculate during masturbation but have difficulty reaching orgasm with a partner.

What can contribute to delayed ejaculation?

Possible contributors include:

• Certain medications, particularly some antidepressants

• Alcohol or substance use

• Anxiety, depression, or performance pressure

• Relationship or communication difficulties

• Nerve injury or neurological conditions

• Diabetes

• Hormonal changes

• Prostate or pelvic surgery

• Certain medical conditions

Because delayed ejaculation can have medical and medication-related causes, a medical evaluation may be appropriate, particularly if the problem is new or has changed significantly.

So What Does the Pelvic Floor Have to Do With It?

The pelvic floor muscles play an important role in sexual function. They contribute to erection, ejaculation, orgasm, and control of the pelvic organs.

However, a healthy pelvic floor is not simply a “strong” pelvic floor. It also needs to be able to relax, contract, and coordinate with breathing and the rest of the body.

For someone experiencing premature ejaculation, the goal may involve improving pelvic floor strength, endurance, coordination, and the ability to recognize and regulate pelvic floor tension and arousal.

For someone experiencing delayed ejaculation, excessive pelvic floor tension or difficulty relaxing the pelvic floor may be one piece of the puzzle. Treatment may focus more heavily on relaxation, breathing, mobility, sensory awareness, and improving coordination.

This is one reason why simply doing more Kegels isn't necessarily the right approach for everyone.

How Can Pelvic Floor Physical Therapy Help?

A pelvic floor physical therapist can perform an individualized evaluation to determine how the pelvic floor may be contributing to sexual symptoms.

Treatment may include:

Pelvic floor coordination
Learning when to contract and, just as importantly, when to relax the pelvic floor.

Breathing and nervous-system regulation
Breathing strategies can help reduce unnecessary muscle tension and improve awareness of changes in arousal and pelvic floor activity.

Strengthening when appropriate
If weakness or poor muscular endurance is contributing to symptoms, a therapist may prescribe a targeted strengthening program.

Down-training and relaxation
For individuals with an overactive or tense pelvic floor, treatment may focus on reducing resting muscle tension rather than strengthening.

Manual therapy
When indicated, hands-on techniques may be used to address pelvic floor or surrounding muscle restrictions and tenderness.

Biofeedback
Biofeedback can help you see and better understand how your pelvic floor muscles are contracting and relaxing, making it easier to learn improved control.

When Should You Seek Help?

You don't have to wait until a sexual concern becomes severe before talking to a healthcare professional.

Consider seeking an evaluation if:

• You consistently ejaculate sooner than you would like and have difficulty delaying it.

• Ejaculation regularly takes much longer than you would like.

• You are unable to ejaculate during partnered sexual activity.

• Your ejaculation pattern has suddenly changed.

• Sexual activity is becoming stressful, frustrating, or something you avoid.

• You experience pelvic pain, erectile difficulties, urinary symptoms, or other changes along with ejaculation problems.

Depending on the cause, treatment may involve a pelvic floor physical therapist, urologist, primary care provider, or sex therapist. In many cases, a combination of approaches provides the best results.

You Don't Have to Just "Live With It"

Premature ejaculation and delayed ejaculation are both common sexual health concerns, and neither is something you should feel embarrassed about.

The key is figuring out why it's happening rather than assuming the answer is simply to strengthen or relax the pelvic floor.

A pelvic floor physical therapy evaluation can help determine whether muscle tension, weakness, coordination, breathing patterns, or other musculoskeletal factors may be contributing to your symptoms — and help develop a treatment plan specific to you.

If ejaculation concerns are affecting your confidence, relationships, or quality of life, consider talking with a healthcare professional. Help is available. 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