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

Psychologic Causes of
Premature Ejaculation


  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. Wyllie MG, Hellstrom WJ (2011) The link between penile hypersensitivity and premature ejaculation. BJU Int 107:452–457
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. Gokce A, Ekmekcioglu O (2010) The relationship between lifelong premature ejaculation and monosymptomatic enuresis. J Sex Med 7:2868–2872
  19. 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
  20. 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
  21. Arletti R, Bazzani C, Castelli M et al (1985) Oxytocin improves male copulatory performance in rats. Horm Behav 19:14–20
  22. 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
  23. 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
  24. Masters WH, Johnson VE (1970) Human sexual inadequacy. Little, Brown & Co, Boston, Kaplan HS (1974) The new sex therapy. Brunner/Mazel, New York
  25. 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
  26. 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
  27. 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
  28. 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
  29. 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
  30. 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
  31. 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
  32. Fichten CS, Spector I, Libman E (1988) Client attributions for sexual dysfunction. J Sex Marital Ther 14(3):208–224
  33. Rowland D, Patrick D, Rothman M, Gagnon D (2007) The psychological burden of premature ejaculation. J Urol 177:1065–1070
  34. 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)
  35. 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
  36. 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

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