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.

  1. 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.
  2. 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.
  3. 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
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.

  • 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.

    Other scientists suspect that anatomical difference like a short frenulum8 or circumcision could cause or contribute to 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?

    Desensitizing products like numbing PE cream and delay spray can help you9.Test

  • 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

    Cerebral/Neurologic Diseases

    • Traumatic brain injury (TBI)11
    • Cerebrovascular disease (CVD) or stroke12
    • Parkinson’s disease (PD)13
    • Epilepsy14
    • Multiple sclerosis (MS)15

    Urological Diseases

    • Chronic prostatitis (CP) or chronic pelvic pain syndrome (CPPS)16
    • Varicocele17
    • Monosymptomatic enuresis (ME) or bedwetting18

    Endocrine Diseases

    • Hyperthyroidism19

    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.

  • Oxytocin

    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

    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.

    Thyroid Hormones

    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

    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
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.

  • 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.

    Social Phobia

    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.

    Anticipatory Anxiety

    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.

  • 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.

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Click here for the complete Bibliography.