Premature Ejaculation: What Causes it?

Between 20 to 30 percent of men have experienced premature ejaculation at some point in their lives. The causes are usually psychological. However, they could also be organic or biological.
Premature Ejaculation: What Causes it?

Last update: 24 March, 2021

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that premature ejaculation is the most common sexual disorder in males. Furthermore, according to data from the American Psychological Association (APA), 27 percent of men in the general population suffer from this condition.

This article discusses the possible physical and psychological causes of this disorder. It’s important to remember that, in the majority of cases, the sufferer has anxiety that could prevent any “normal” ejaculation response.

What’s premature ejaculation?

The DSM-5 defines premature ejaculation as a persistent or recurrent pattern of ejaculation occurring during sexual activity within one minute of vaginal penetration and before the individual desires it.

This disorder can also affect people who have non-penetrative sex. However, the one-minute criteria doesn’t apply here. Nevertheless, ejaculation still occurs before the individual wants it to.

A man sitting on the edge of the bed.

The causes of premature ejaculation

The most frequent cause of premature ejaculation is that the defective response has been learned in sexual situations where there’s a significant degree of anxiety. In addition, once this “faulty” response has been learned, it becomes difficult to control the reflex voluntarily. This is because the ejaculation response is controlled by the sympathetic nervous system. Therefore, anxiety will make premature ejaculation more likely.

However, there are other possible causes of this disorder, some of which may be medical.

The psychological causes of premature ejaculation

As we mentioned above, premature ejaculation is a problem that’s usually related to anxiety. Indeed, anxiety is one of its main causes. However, here are some other psychological reasons:

  • Early sexual experiences.
  • Sexual abuse in childhood (or later).
  • Depression or depressive symptoms.
  • Body image problems or complexes.
  • Concern about the problem itself.
  • Self-imposed high demands.
  • Pressure to “live up to expectations”.
  • Chronic and prolonged stress.
  • Feelings of guilt, which cause a tendency to rush during intercourse.
  • Relationship problems.

Physical causes of premature ejaculation

Some of the most common are:

  • Inflammation and infection of the urethra.
  • Hereditary traits.
  • Multiple sclerosis.
  • Erectile dysfunction.
  • Abnormal hormone levels.
  • Inflammation and infection of the prostate (prostatitis).
  • Opiate withdrawal.
  • Thyroid disease.

Risk factors

There are three types of risk factors for premature ejaculation:

  • Temperamental. It’s more common in men who suffer from anxiety, especially those with social anxiety disorder (social phobia).
  • Genetic and physiological. These problems are related to dopamine and serotonin (genetic polymorphisms).

Epidemiology, course, and comorbidity

More than 20 to 30 percent of men between the ages of 18 and 70 have reported episodes of premature ejaculation. However, with the new definition from the DSM-V (the one-minute criteria), only one to three percent of men would be diagnosed with the condition.

The course and development of the disorder vary. Premature ejaculation might begin with a male’s first sexual experiences and continue throughout their life. However, it’s usual for them to gain some control over the condition in time.

In terms of comorbidity, the disorder can also be associated with erection problems. In fact, in these cases, it’s sometimes difficult to know which problem occurred first.

The two types of premature ejaculation: lifelong and acquired

There are two types of premature ejaculation. Firstly, the lifelong one, which occurs from the first sexual experience, usually due to anxiety and which often disappears over time. Secondly, the acquired kind, usually associated with certain medical conditions.

The first type is normally linked to certain anxiety disorders. However, the second might be associated with diseases such as prostatitis, thyroid disease, or drug withdrawal.

A man suffering from premature ejaculation.

Final note

As you can see, this disorder has many different causes. Psychological causes tend to be the most common, especially anxiety. This is because anxiety tends to be physiologically incompatible with the kind of erection that doesn’t result in premature ejaculation.

However, each case is different, and the first step to a remedy is finding the root cause. In other words, is it medical, biological, relational, or psychological? Once that’s been established, the disorder can be treated accordingly. Finally, it goes without saying that professional medical assistance can prove helpful.

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  • American Psychiatric Association –APA- (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid: Panamericana.
  • Belloch, A., Sandín, B. y Ramos, F. (2010). Manual de Psicopatología. Volumen I y II. Madrid: McGraw-Hill.