Causes of Premature Ejaculation
When we suffer from Premature Ejaculation, our first question is often about the causes. Why am I ejaculating faster than other men? Is it psychological or physical? Most of the time, it’s both. Although the exact causes of premature ejaculation are still up to debate, most specialists agree that it’s probably multicausal. There is not a single cause to a premature ejaculation problem, but several risk factors which may trigger the problem or worsen it.
About the Causes
Before we analyze each potential cause of premature ejaculation, we need to clarify some things.
- Premature Ejaculation can be split into 4 subtypes: Lifelong PE, Acquired PE, Variable PE, and Subjective PE. Specialists suspect that each of these subtypes has its own potential causes. For example, we suspect Lifelong PE to have more organic risk factors. For more information on each subtype, you can read the What is Premature Ejaculation page.
- I’ll be using the word “cause” for a general term that incorporates different concept such as “risk factor” and “aggravating factors”. If you want the details, you can read our blog post that explains the difference between a cause and a risk factor. For simplicity sake, we use the term cause as a synonym of suspected cause, risk factor and aggravating factor on this page.
- We split up the causes into two categories: organic and psychological. The goal of this division is to stress out the organic risk factors since PE is still considered by some as a purely psychological condition. However, the distinction between an organic and a physical risk factor isn’t so clear since a psychological condition has organic impacts and vice versa.
You can click on each image to read more about each premature ejaculation cause
Organic Causes of
Nervous System ImbalanceNeurologic factors (like your serotonin level) could cause premature ejaculation.
Ejaculation is a complex process that involves nerves in the brain, the spinal cord, and the pelvic area. Those part “communicate” with each other when you are aroused. They communicate via your nervous system.
When your partner touch you – or when you see something that turns you on – your brain and your sensory receptor pass the information that you are turned on to your spinal cord. When you’re spinal cord is too much excited, the ejaculatory reflex is triggered.
Researchers suspect that premature ejaculators (especially lifelong premature ejaculator) have a more sensitive nervous system1.
Communication in the nervous system is made via neurotransmitters. We know that some antidepressant drugs extend the time of ejaculation. Those drugs (like the selective serotonin reuptake inhibitor – or SSRI) influence your level of serotonin, a neurotransmitter that contributes to the feelings of well-being, happiness.
The exact mechanism of how serotonin influence ejaculation control is not completely understood, but some data suggest that SSRI drug may desensitize serotonin receptors on oxytocin neurons (you can read more on oxytocin in the endocrine control section).
Although most of the research on the neurologic cause of premature ejaculation have been focused on serotonin, other neurotransmitters are also involved in the ejaculatory reflex. So, ejaculatory control is (at least partially) influenced by your brain chemistry, which is in part hereditary2. Thus, there would be a genetic factor to premature ejaculation.
How do I know if my premature ejaculation problem is caused by a nervous system imbalance?
There is no simple way to check if your serotonin level is fine or not. Still, we can suspect a neurologic caused PE if you suffer from lifelong PE (you can pass the premature ejaculation test if you want to know). If traditional treatments like sex therapy don’t work, then a nervous system imbalance could explain your PE.
What can I do if I suspect that my premature ejaculation problem is caused by a nervous system imbalance?
Some antidepressant drugs can influence your level of serotonin, but those drugs can have side effects and contraindication. Before considering a drug treatment for PE, you should try other methods first like a home therapy, a professional sex therapy or ejaculation delay products. If those treatment doesn’t work, you should talk to your doctor about drug treatment.
If you are considering a drug treatment, always talk to your doctor first and do not use this medicine without a prescription.
Penile HypersensitivityA hypersensitive penis more responsive to genital stimulation could cause premature ejaculation
There is a debate in the scientific community as to whether some men with premature ejaculation have a more sensitive penis. Some studies show that the brain of men suffering from PE present higher electrical activity when touched in the genital area (Somatosensory evoked potential – or SEPs)3. Premature ejaculators are also more sensitive to vibrations (penile biothesiometry)4.
On the other hand, other studies mitigate or contradict those results5. These studies show no correlation between ejaculation time and genital hypersensitivity. One study even suggests that lifelong PE may be linked to a lack of sensitivity (hyposensitivity) instead than a hypersensitivity6. Here again, more research would be needed to clarify the issue.
Still, some researchers noted7 that all those studies have been completed before the completed before the new Premature Ejaculation definition by the International Society of Sexual Medicine. It’s possible that penile hypersensitivity is a risk factor that contributes to premature ejaculation only for some specific subjects of a specific subtype of PE.
How do I know if my premature ejaculation problem is caused by a penile hypersensitivity?
The test used in researches (somatosensory evoked potential and penile biothesiometry) aren’t possible to pass for oneself. One good way to test penile hypersensitivity is to try the PE training unit test.
What can I do if I suspect that my premature ejaculation problem is caused by a penile hypersensitivity?
Injury, Trauma, and DiseasesSome injury to the spinal cord and some cerebral or urological diseases could cause premature ejaculation
You can find here a list of some diseases that specialists link to premature ejaculation problems. It is sometimes difficult to tell if those conditions are the cause, a contributing factor, a correlate or a consequence of PE.
Injury and Trauma
- Lesions of the Spinal Cord – Spinal cord injury (SCI)10
- Traumatic brain injury (TBI)11
- Cerebrovascular disease (CVD) or stroke12
- Parkinson’s disease (PD)13
- Multiple sclerosis (MS)15
- Chronic prostatitis (CP) or chronic pelvic pain syndrome (CPPS)16
- Monosymptomatic enuresis (ME) or bedwetting18
How do I know if my premature ejaculation problem is caused by an injury, trauma or diseases?
Well, if your ejaculation problem occurred after a spinal cord injury, it should be easy to pinpoint the cause of tour problem.
For the diseases, if you have been diagnosed with one of the medical conditions listed below, you should talk to your doctor about the potential link between your PE and your disease.
What can I do if I suspect that my premature ejaculation problem is caused by an injury, trauma or diseases?
The first thing you should do is to talk to your doctor about your condition and your PE problem. He is in the best position to investigate the relationship between your diseases and your PE problem.
Endocrine Control (hormones level)A higher than average level of some hormones (like oxytocin and testosterone) could cause premature ejaculation.
Studies show that hormones such as oxytocin (OT)20 play a major role in the ejaculation mechanism. One particular study21 infused oxytocin in male rats brain before sex. The oxytocin-infused rats had shorter ejaculation latencies and refractory period than normal rats. However, intranasal oxytocin spray doesn’t seem to modify sexual behavior on human22. One reason which may explain this is the fact that oxytocin doesn’t pass the blood-brain barrier. Therefore, there is no simple way to modify the oxytocin level of an individual other than drugs that influence your central nervous system (5-HT1A serotonin receptors) that produce oxytocin. This may explain why some antidepressant drugs can delay ejaculation (see nervous system imbalance for more details)
Testosterone is another hormone associated with the ejaculation reflex. We know that a low level of testosterone can make ejaculation difficult23 and can be a cause of delayed ejaculation.
Hypo and Hyperthyroidism have been linked with delayed and premature ejaculation19. The same study also concluded that thyroid hormone (TSH) levels can influence ejaculation latency time even for people who do not suffer from hyperthyroidism.
Other hormones such as Estrogen and Prolactin also play a role in the male ejaculation mechanism.
How do I know if my premature ejaculation problem is caused by my endocrine control?
Endocrine testing isn’t simple. For example, for some hormones like oxytocin, we aren’t sure if the level of oxytocin in the blood is a good indication of the brain level and obtaining cerebrospinal fluid is way more complex than simply passing a blood test.
Although scientists suspect a hormonal risk factor to premature ejaculation, how each hormone contributes to the ejaculation reflex is still not understood. Moreover, testing the hormone level won’t be useful until scientists develop an effective hormonal therapy.
For those reasons, hormones test for premature ejaculation isn’t possible for now. Just like the nervous system imbalance risk factor, we can suspect a hormonal implication for lifelong PE, but we can know for sure.
What can I do if I suspect that my premature ejaculation problem is caused by my endocrine control?
Just like the nervous system imbalance, there is no way to confirm a hormonal implication to your PE. However, antidepressants drugs that influence your level of serotonin also influence your oxytocin level via the 5-HT1A serotonin receptors. Yet, before you consider a drug treatment for PE, you should try other methods like a home therapy, a professional sex therapy or ejaculation delay products. If those treatment doesn’t work, you should talk to your doctor about drug treatment.
If you are considering a drug treatment, always talk to your doctor first and do not use this medicine without a prescription.
Psychologic Causes of
Lack of Psychosexual SkillsSome learned behaviors associated with a bad arousal response could cause premature ejaculation
In the 70s, Masters and Johnson proposed a behavioral explanation to premature ejaculation. For them, premature ejaculation was caused by a bad sexual learning. Men who suffered from Premature Ejaculation simply didn’t learn how to control their arousal. Since the first time they masturbated, they’ve always ejaculate quickly. It was described as a conditioning problem just like Pavlov’s dog. This lack of sexual skills has been considered as the main cause of Premature Ejaculation for about 40 years.
Master and Johnson have developed some behavioral therapies to “re-educate” rapid ejaculators. Although their techniques have shown some initial success24, modern studies questioned their effectiveness25. As you can read on this page, Premature Ejaculation is a far more complex condition. It can’t be summarized by only one cause.
Still, the initial success of Master and Johnson method may indicate that there is a learned component at Premature Ejaculation. Even if the lack of psychosexual skills can’t explain all PE problems, behavioral therapy (by a professional sex therapist or by yourself) is still the first thing you should try to get rid of your Premature Ejaculation problem. This kind of therapy helps you to learn how to identify and control your level of arousal.
Is it also interesting to note that Premature Ejaculators are more prone to Alexithymia26 . Alexithymia is the lack of ability to perceive and interpret the signs of emotional arousal. This is another clue that some premature ejaculators may have trouble to identify and regulate their own arousal.
How do I know if my premature ejaculation problem is caused by a lack of psychosexual skill?
If you suffer from Lifelong PE and you’ve always ejaculate early, it’s possible that your PE is caused (at least in part) by a lack of psychosexual skills. You can take a look at the pages below to address this issue first and see how much your condition improves.
What can I do if I suspect that my premature ejaculation problem is caused by a lack of psychosexual skill?
Master and Johnson developed some exercises to overcome premature ejaculation caused by a lack of psychosexual skill. You can do those exercises by yourself in a homemade behavioral therapy or within a professional sex therapy with a certified therapist.
Psychologic Conditions and AnxietySome psychological conditions like anxiety or depression could cause, or contribute to, premature ejaculation
Several studies advance that men with PE could have specific psychological traits. Whether those traits are causing/contributing to the PE condition, or a result of this condition, is unclear.
Anxiety and Depression
Several studies link PE with higher personal distress, interpersonal difficulty, lower self-positive image, diminished quality of life, higher general emotional distress, feelings of inadequacy and self-esteem problems27. Even if those traits aren’t the root cause of the Premature Ejaculation, it’s possible that they could sustain or worsen the problem.
Not only does premature ejaculators are more prone to anxiety and depression28, but they also react more than normal to negative stimuli29. It is interesting to note that this increased sensibility is reduced by an ejaculatory-retarding drug like clomipramine.
Some studies show that anxiety increases the arousal level30, which may explain the link between anxiety and PE.
Other studies have linked PE with social anxiety31. In most case, those social phobias appeared before the PE condition which means that social anxiety may be a contributing/aggravating factor to Premature Ejaculation.
The way someone reacts to rapid ejaculation may worsen his PE condition. A study shows that people who attribute their problem to external reason (such as alcohol consumption) are less prone to anticipatory anxiety which could be an aggravating/contributing factor of Premature Ejaculation32.
How do I know if my premature ejaculation problem is caused by a psychological condition?
If you suffer from one of those psychologic conditions like anxiety, depression or social phobia, your PE could be aggravated by it. It’s best to treat this condition first.
What can I do if I suspect that my premature ejaculation problem is caused by a psychological condition?
Depression, anxiety and social phobia are serious medical conditions that should be treated. If you think you may suffer from one of those conditions, you should consult a doctor.
It is no surprise that a couple where the man suffers from PE has a lower level of sexual satisfaction and a higher level of personal distress than the average couple33. It’s hard to tell how much does a relationship could contribute to the problem, but we know that therapies where the partner is actively participating are generally more successful34. Therefore, just as a good relationship could help your chances to overcome your problem, a bad relationship may be a contributing/aggravating factor.
How do I know if my premature ejaculation problem is caused by relational issues?
If you don’t ejaculate early with every partner, but only with some specific ones, it’s possible that your PE is caused by relational issues.
What can I do if I suspect that my premature ejaculation problem is caused by relational issues?
If you suspect relational issues to cause or contribute to your PE, professional sex therapy and counseling is the first treatment you should seek.
Other Sexual DysfunctionsOther sexual difficulties, like erectile dysfunction or some female sexual dysfunctions, could cause premature ejaculation
Erectile Dysfunction (ED)
There is a correlation between erectile dysfunction and premature ejaculation35. We do not know if ED is the cause or the consequence of PE. Many researcher believe that both condition contribute to each other inside a vicious circle. You can read more on how ED and PE are linked on our answer to Is There a Link Between Premature Ejaculation And Erectile Dysfunction?
Female Sexual Dysfunction
Your partner sexual dysfunction may also cause or contribute to your premature ejaculation problem36. Two female sexual dysfunctions often linked with PE are vaginism and hypoactive sexual desire.
Vaginism is a condition where a woman suffers from involuntary vaginal muscle spasm. Those spam could make the vaginal penetration impossible or painful. It can also exacerbate the pressure on the man’s penis and cause early ejaculation. In the case of hypoactive sexual desire, when the woman someone suffers from a lack of libido, it’s more a psychological pressure that could participate to the early ejaculation.
How do I know if my premature ejaculation problem is caused by other sexual dysfunction?
If you or your partner suffer from another sexual dysfunction, you should know. You should consider a sex therapy or a talk with a doctor to know which dysfunction you should treat first.
What can I do if I suspect that my premature ejaculation problem is caused by other sexual dysfunction?
If you suspect an other sexual dysfunction to cause or contribute to your PE, professional sex therapy should help you. In the case of erectile dysfunction, you should talk to your doctor if you consider drug treatment. ED drugs like Viagara or Cialis can sometimes be used to treat erectile dysfunction with PE.
- Waldinger MD, Berendsen HHG, Blok BFM, Olivier B, Holstege G (1998) Premature ejaculation and SSRI-induced delayed ejaculation: the involvement of the serotonergic system. Behav Brain Res 92:111–118
- Waldinger MD, Rietschel M, Nothen MM, Hengeveld MW, Olivier B (1998) Familial occurrence of primary premature ejaculation. Psychiatr Genet 8:37–40 – Read more on the Is Premature Ejaculation Genetic or Hereditary page
- Fanciullacci F, Colpi GM, Beretta G, Zanollo A (1988) Cortical evoked potentials in subjects with true premature ejaculation. Andrologia 20:326–330, Xin ZC, Choi YD, Rha KH, Choi HK (1997) Somatosensory evoked potentials in patients with primary premature ejaculation. J Urol 158:451–455
- Xin ZC, Chung WS, Choi YD, Seong DH, Choi YJ, Choi HK (1996) Penile sensitivity in patients with primary premature ejaculation. J Urol 156:979–981
- Perretti A, Catalano A, Mirone V, Imbimbo C, Balbi P, Palmieri A, Longo N, Fusco F, Verze P, Santoro L (2003) Neurophysiologic evaluation of central-peripheral sensory and motor pudendal pathways in primary premature ejaculation. Urology 61:623–628, Paick JS, Jeong H, Park MS (1998) Penile sensitivity in men with premature ejaculation. Int J Impot Res 10:247–250, Vanden Broucke H, Everaert K, Peersman W, Claes H, Vanderschueren D, Van Kampen M (2007) Ejaculation latency times and their relationship to penile sensitivity in men with normal sexual function. J Urol 177:237–240
- Salonia A, Saccà A, Briganti A, Carro UD, Dehò F, Zanni G, Rocchini L, Raber M, Guazzoni G, Rigatti P, Montorsi F (2009) Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation: a case-controlled study. J Sex Med 6:1755–1762
- Wyllie MG, Hellstrom WJ (2011) The link between penile hypersensitivity and premature ejaculation. BJU Int 107:452–457
- Gallo L, Perdona S, Gallo A (2010) The role of short frenulum and the effects of frenulectomy on premature ejaculation. J Sex Med 7(3):1269–1276
- Xin ZC, Choi YD, Seong DH, Choi HK (1995) Sensory evoked potential and effect of SScream in premature ejaculation. Yonsei Med J 36:397–401, Xin ZC, Choi YJ, Choi YD, Ryn JK, Seong DH, Choi HK (1995) Local anaesthetic effects of SS cream in patients with premature ejaculation. J Korean Androl Soc 13:31–37
- Williams W (1984) Secondary premature ejaculation. Aust N Z J Psychiatry 18:333–340, Kuhr CS, Heiman J, Cardenas D, Bradley W, Berger RE (1995) Premature emission after
spinal cord injury. J Urol 153:429–431
- Garden FH, Bontke CF, Hoffman M (1990) Sexual functioning and marital adjustment after traumatic brain injury. J Head Trauma Rehabil 5:52–59, Kreuter M, Dahllof A-G, Gudjonsson G, Sullivan M, Siösteen A (1998) Sexual adjustment and its predictors after traumatic brain injury. Brain Inj 12:349–368, Meyer JE (1955) The sexual dysfunction of the brain injury. Eur Arch Psychiatry Clin Neurosci 193:449–469
- Jung JH, Kam SC, Choi SM, Jae SU, Lee SH, Hyun JS (2008) Sexual dysfunction in male stroke patients: correlation between brain lesions and sexual function. Urology 71:99–103
- Brown RG, Jahanshahi M, Quinn N, Marsden CD (1990) Sexual function in patients with Parkinson’s disease and their partners. J Neurol Neurosurg Psychiatry 53:480–486, Bronner G, Royter V, Korczyn AD, Giladi N (2004) Sexual dysfunction in Parkinson’s disease. J Sex Marital Ther 30:95–105, Wielinski CL, Varpness SC, Erickson-Davis C, Paraschos AJ, Parashos SA (2010) Sexual and relationship satisfaction among persons with young-onset Parkinson’s disease. J Sex Med 7:1438–1444
- Fenwick PB, Toone BK, Wheeler MJ, Nanjee MN, Grant R, Brown D (1985) Sexual behavior in a centre for epilepsy. Acta Neurol Scand 71:428–435, Herzog AG (1991) Reproductive endocrine considerations and hormonal therapy for men with epilepsy. Epilepsia 32:S24–S37, Hamed SA (2008) Neuroendocrine hormonal conditions in epilepsy: relationship to reproductive and sexual functions. Neurologist 14:157–169
- Tepavcevic DK, Kostic J, Basuroski ID, Stojsavljevic N, Pekmezovic T, Drulovic J (2008) The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult Scler 14:1131–1136
- Liang CZ, Zhang XJ, Hao ZY et al (2004) Prevalence of sexual dysfunction in Chinese men with chronic prostatitis. BJU Int 93:568–570 Screponi E, Carosa E, Di Stasi SM et al (2001) Prevalence of chronic prostatitis in men with premature ejaculation. Urology 58:198–202 Shamloul R, el-Nashaar A (2006) Chronic prostatitis in premature ejaculation: a cohort study in 153 men. J Sex Med 3:150–154
- Lotti F, Corona G, Mancini M et al (2009) The association between varicocele, premature ejaculation and prostatitis symptoms: possible mechanisms. J Sex Med 6:2878–2887
- Gokce A, Ekmekcioglu O (2010) The relationship between lifelong premature ejaculation and monosymptomatic enuresis. J Sex Med 7:2868–2872
- Carani C, Isidori AM, Granata A (2005) Multicenter study on the prevalence of sexual symptoms in male hypo- and hyperthyroid patients. J Clin Endocrinol Metab 90:6472–6479
- Vignozzi L, Filippi S, Morelli A et al (2008) Regulation of epididymal contractility during semen emission, the first part of the ejaculatory process: a role for estrogen. J Sex Med 5:2010–2016, de Jong TR, Veening JG, Olivier B et al (2007) Oxytocin involvement in SSRI-induced delayed ejaculation: a review of animal studies. J Sex Med 4:14–28
- Arletti R, Bazzani C, Castelli M et al (1985) Oxytocin improves male copulatory performance in rats. Horm Behav 19:14–20
- Burri A, Heinrichs M, Schedlowski M et al (2008) The acute effects of intranasal oxytocin administration on endocrine and sexual function in males. Psychoneuroendocrinology 33:591–600
- Corona G, Mannucci E, Petrone L et al (2006) Psychobiological correlates of delayed ejaculation in male patients with sexual dysfunctions. J Androl 27:453–458, Corona G, Jannini EA, Mannucci E et al (2008) Different testosterone levels are associated with ejaculatory dysfunction. J Sex Med 5:1991–1998, Corona G, Jannini EA, Lotti F et al (2011) Premature and delayed ejaculation: two ends of a single continuum inluenced by hormonal milieu. Int J Androl 34:41–48
- Masters WH, Johnson VE (1970) Human sexual inadequacy. Little, Brown & Co, Boston, Kaplan HS (1974) The new sex therapy. Brunner/Mazel, New York
- Rowland DL, Cooper SE, Slob AK (1998) The treatment of premature ejaculation: psychological and biological strategies. Drugs Today (Barc) 34(10):879–899, Rowland D, Cooper S, Macias L (2008) Pharmaceutical companies could serve their own interests by supporting research on the eficacy of psychotherapy on premature ejaculation. Int J Impot Res 20(2):115–120, De Carufel F, Trudel G (2006) Effects of a new functional-sexological treatment for premature ejaculation. J Sex Marital Ther 32:97–11
- Michetti PM, Rossi R, Bonanno D, De Dominicis C, Iorl F, Simonelli C (2007) Dysregulation of emotions and premature ejaculation (PE): alexithymia in 100 outpatients. J Sex Med 4(5):1462–1467
- McCabe MP (1997) Intimacy and quality of life among sexually dysfunctional men and women. J Sex Marital Ther 23(4):276–290, Rowland DL, Patrick DL, Rothman M, Gagnon DD (2007) The psychological burden of premature ejaculation. J Urol 177(3):1065–1070, Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho FK et al (2005) Premature ejaculation: an observational study of men and their partners. J Sex Med 2:358–367, Rosen RC, Althof S (2008) Impact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences. J Sex Med 5(6):1296–1307, Revicki D, Howard K, Hanlon J, Mannix, Greene A, Rothman M (2008) Characterizing the burden of premature ejaculation from a patient and partner perspective: a multi-country qualitative analysis. Health Qual Life Outcomes 6:33, Tondo L, Cantone M, Carta M, Laddomada A, Mosticoni R, Rudas N (1991) An MMPI evaluation of male sexual dysfunction. J Clin Psychol 47:391–396
- Munjak DJ, Kanno PH, Oziel LJ (1978) Ejaculatory disorders: some psychometric data. Psychol Rep 43(3):783–787, Corona G, Petrone L, Mannucci E, Jannini EA, Mansani R, Magini A, Giommi R, Forti G, Maggi M (2004) Psycho-biological correlates of rapid ejaculation in patients attending an andrologic unit for sexual dysfunctions. Eur Urol 46(5):615–622
- Rowland DL, Tai WL, Slob AK (2003) An exploration of emotional response to erotic stimulation in men with premature ejaculation: effects of treatment with clomipramine. Arch Sex Behav 32(2):145–153
- Beck JG, Barlow DH (1986) The effects of anxiety and attentional focus on sexual responding I: physiological patterns in erectile dysfunction. Behav Res Ther 24:9–17, Heiman JR, Rowland DL (1983) Affective and physiological sexual response patterns: the effects of instructions on sexually functional and dysfunctional men. J Psychosom Res 27:105–116, Rowland DL, Georgoff V, Burnett A (2011) Psychoaffective differences between sexually functional and dysfunctional men in response to a sexual experience. J Sex Med 8:132–1
- Corretti G, Pierucci S, De Scisciolo M, Nisita C (2006) Comorbidity between social phobia and premature ejaculation: study on 242 males affected by sexual disorders. J Sex Marital Ther 32(2):183–187, Figueira I, Possidente E, Marques C, Hayes K (2001) Sexual dysfunction: a neglected complication of panic disorder and social phobia. Arch Sex Behav 30(4):369–377
- Fichten CS, Spector I, Libman E (1988) Client attributions for sexual dysfunction. J Sex Marital Ther 14(3):208–224
- Rowland D, Patrick D, Rothman M, Gagnon D (2007) The psychological burden of premature ejaculation. J Urol 177:1065–1070
- Rowland DL, Cooper SE, Slob AK (1998) The treatment of premature ejaculation: psychological and biological strategies. Drugs Today (Barc) 34(10):879–899, Rowland DL, Cooper SE (2011) Practical tips for sexual counseling and psychotherapy in premature ejaculation. J Sex Med (accepted for publication)
- Jannini EA, Lombardo F, Lenzi A (2005) Correlation between ejaculatory and erectile dysfunction. Int J Androl 28(Suppl 2):40–45 – Read more on Is There a Link Between Premature Ejaculation And Erectile Dysfunction? page
- Rowland D, McMahon CG, Abdo C, Chen J, Jannini E, Waldinger MD, Ahn TY (2010)
Disorders of orgasm and ejaculation in men. J Sex Med 7:1668–1686, Dogan S, Dogan M (2008) The frequency of sexual dysfunctions in male partners of women with vaginismus in a Turkish sample. Int J Impot Res 20:218–221