What Causes Premature Ejaculation?

May 10, 2021

Problems in the bedroom are one of the hardest things for men to discuss. Although it may feel like an isolating experience, sexual concerns such as premature ejaculation are relatively common. In fact, between 30% and 40% of men will be affected during their lifetime.

While there's still a lot left to learn about this particular condition, there are several available treatments for premature ejaculation. Read on to understand why and how this frustrating condition happens, and what you can do about it. 

How Does Ejaculation Work?

Ejaculation is controlled largely by the central nervous system. When a man becomes sexually stimulated, signals are sent to the brain, spinal cord, and nervous system. When a man reaches a certain level of excitement, signals are then sent from the brain to the reproductive organs. These signals then cause a contraction of muscles at and around the basis of the penis and semen to be propelled through the penis, creating the process known as ejaculation. There are two phases to ejaculation:


The first phase is called emission and occurs when sperm moves from the testicles, where they're created on an ongoing basis, to the prostate, where it mixes with seminal fluid in order to create semen. The vasa deferentia are tubes that help to move the sperm from the testicles and through the prostate all the way to the base of the penis.


The second phase of the ejaculation process is the expulsion phase. This occurs when the muscles at the base of the penis contract. As a result, semen is forcefully expelled from the urethra and out of the penis. Generally, ejaculation and orgasm occur at the same time, but not in all cases, as some men can climax without ejaculating. Typically, erections begin to subside after expulsion. 

What is Premature Ejaculation?

Premature ejaculation occurs whenever a man has an orgasm and the process described above is completed sooner than he or his partner would like.

In many cases, premature ejaculation (PE) happens just before or shortly after penetrative sex or during foreplay. The circumstances vary, and some men may experience PE before there's even physical touch involved. 

No matter the specifics, PE occurs when ejaculation is before you intended.

The exact scientific definition of premature ejaculation varies, but the American Psychiatric Association lists three levels of severity based on the time it takes to ejaculate: mild, moderate, and severe. Mild is classified as ejaculation occurring in under one minute; moderate is when ejaculation occurs 15-30 seconds after vaginal penetration; and severe happens when ejaculation occurs prior to penetration, upon penetration, or < 15 seconds after vaginal penetration.

Premature ejaculation is perfectly normal to experience occasionally, but if it happens frequently then it could be the sign of a more serious issue. 

These are some of the symptoms of a more persistent form of premature ejaculation:

  • Ejaculation always, or almost always, occurs before sexual penetration has been achieved, or within one minute of penetration.
  • There is an inability to delay ejaculation every time, or almost every time, that penetration occurs.
  • Negative personal consequences are experienced, such as frustration, distress, or an avoidance of sexual intimacy in general. 

There are some psychological symptoms that may come as a secondary event to the physical ejaculatory issues.

Either the man, his partner, or both of them might experience:

  • Anxiety
  • Decreased level of confidence in the relationship
  • Depression
  • Embarrassment
  • Interpersonal difficulties
  • Mental distress

While men experiencing premature ejaculation tend to endure psychological distress as a result, a study of 152 men and their partners suggests that the partner will be less worried about the premature ejaculation than the man experiencing it. In other words, guys are more worried about the PE than their partners are.

How is Premature Ejaculation Diagnosed?

If you're experiencing frequent premature ejaculation, or if the worry about premature ejaculation is causing anxiety or affecting your relationship, you should schedule an appointment with a physician. Doctors will begin the exam by asking you a series of questions about your sexual experiences. 

Common questions they might ask include:

  • How long have you been experiencing premature ejaculation?
  • Under what circumstances does premature ejaculation occur most often?
  • How often do you experience premature ejaculation?
  • Does premature ejaculation occur with every sexual attempt?
  • Does premature ejaculation happen with all sexual partners or just one in particular?
  • Does premature ejaculation occur whenever you masturbate?
  • Do you have any difficulty achieving or maintaining an erection?
  • What type of sexual activity (such as foreplay, masturbation, intercourse, use of visual cues, etc) do you take part in and how often do you?
  • How has premature ejaculation changed your sexual activity?
  • How are your personal relationships with your partners?
  • Is there anything you do (drugs, alcohol, etc) that impacts the premature ejaculation for better or worse? 
  • How much stimulation is required to bring on ejaculation?
  • Can you delay ejaculation until after penetration or is there no control whatsoever?

What Causes Premature Ejaculation?

There's no a single clear or direct cause of premature ejaculation. However, there are a few risk factors that have been identified, along with other issues that could potentially cause premature ejaculation to occur. These are some of the common potential causes:

Psychological Issues

Psychological or mental health issues can be heavily involved in the occurrence of premature ejaculation, such as:

  • Anxiety
  • Depression
  • Early sexual experiences
  • Feeling of guilt or inadequacy
  • History of sexual repression
  • Lack of confidence
  • Poor body image 
  • Relationship issues
  • Sexual abuse
  • Sexual inexperience
  • Stress
  • Unrealistic expectations about sex and sexual performance
  • Worrying about the possibility of premature ejaculation

Biological Causes

Although much more rare, there may be a physiological cause to premature ejaculation. Some of the following are possible medical causes of premature ejaculation:

  • Abnormal hormone levels
  • Abnormal level of brain chemicals and neurotransmitters
  • Diabetes
  • Excessive consumption of alcohol
  • Illicit drug use
  • Inflammation and infection of the urethra or prostate
  • Inherited traits and genetics
  • Multiple sclerosis
  • Prostate disease
  • Thyroid issues


Aging is not a direct cause of premature ejaculation, as it can occur in men of all ages, but aging does result in changes to erections and ejaculation in general, so it’s possible that age could play a role in premature ejaculation. 

For older men, erections may not be as firm or as large as they used to be. Men might also not last as long before ejaculation occurs, or the feeling that ejaculation is imminent might be much shorter than it was. Any of these changes could result in an older man ejaculating earlier than desired.

Erectile Dysfunction

You could be at an increased risk of developing premature ejaculation if you occasionally or consistently have trouble achieving or maintaining an erection. Fear of losing your erection could cause you to consciously or unconsciously hurry through sexual encounters, resulting in premature ejaculation. Treating erectile dysfunction could help to eliminate this fear of a lost erection and help to extend the length of sexual activities. 


When premature ejaculation happens, it’s possible to start losing some of the closeness and bond shared with a sexual partner. You may begin to feel angry or upset, and even turn away from your partner. Your partner may feel the same emotions. 

Premature ejaculation can result in partners feeling hurt and less connected to one another. These problems could end up making the premature ejaculation occurrences more frequent due to these negative emotions and associated stress or performance anxiety. 

Are There Treatments For Premature Ejaculation?

Luckily, there are many treatment options available for premature ejaculation depending on the root cause. Most commonly, they include behavioral therapy, counseling, and often men's health medications

Most of the causes of premature ejaculation deal with psychological issues, so therapy and counseling are a good place to start. Medications are also a treatment option. Most antidepressants can delay premature ejaculation and anesthetic creams or sprays can physically numb the penis, delaying pleasure or sensation as well. In some cases, effective erectile dysfunction medications like Viagra® and Cialis® can actually be used to treat premature ejaculation. 

The Takeaway: While there is no clear, single direct cause of premature ejaculation, there are plenty of known contributing factors and risks. Most of them are psychological in nature, including stress, anxiety, or depression, but sometimes biological factors like a hormonal imbalance or low serotonin levels may be the culprit.

If you're dealing with premature ejaculation more often than you think you should be, consider talking to a physician. Rex MD can help with prescription medications delivered, if appropriate, and the help of a licensed physician available by message or phone. Get started with your online consultation today.

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Disclaimer : This article is for information only and should not be considered medical advice. Always speak with your doctor about your health and the benefits or risks of any treatment or intervention. This information should not be relied on as a substitute for professional medical advice.