The exact cause of premature ejaculation (PE) is unknown but it may be due to a number of different factors, both physical and psychological, that vary from person-to-person.1
Physical causes of PE
Ejaculation is controlled by the central nervous system via neurotransmitters; chemicals that are released by nerve cells in the brain. The neurotransmitter that helps to prevent ejaculation is called serotonin, and it is thought that in some cases, PE may be caused by a disruption in the levels of serotonin or the serotonin signaling in the brain.2,3
Other physical causes of PE can include having an overly sensitive penis or having abnormal reflex activity of the ejaculation system. Other medical conditions, or side-effects experienced with other medications, may also cause PE.3
Psychological causes of PE
The psychological causes of PE can be wide-ranging and vary greatly from person-to-person.1,4,5
Sometimes psychological issues can be a result of PE rather than a cause, as they can come from the emotional reactions and frustration felt after PE has occurred. These feelings can make the condition worse as they can become a weight on a patient’s mind as well as their partners.6
No matter if these issues are the cause of or a result of PE, talking to a doctor can be the first step to breaking this cycle and finding a solution.
There are two different types of PE: lifelong PE (primary) and acquired PE (secondary)
About 65% of men who have PE have lifelong PE. As the name suggests, it is a condition that will often start from the first sexual experience, and will continue throughout life.7 It is thought to be caused by both physical and psychological factors and can be genetic.2
Many men live for years without any ejaculation problems, and then gradually or suddenly, they start to experience PE.7 This is known as acquired PE and can be caused by social, psychological or relationship problems – it even can be a side-effect of some medications.2 Acquired PE can also be related to other conditions such as an overactive thyroid, erectile dysfunction or other prostate related conditions. The treatment of these other conditions can often relieve a man of their PE symptoms.2
Situational PE is a type of acquired PE that occurs with just one partner. It is most probably due to psychological problems related to the situation, the partner or the relationship.
Although genital sensitivity may contribute to the development of premature ejaculation (PE) symptoms, experts now recognise that PE is a multidimensional condition that can involve psychological, physical, hormonal and neurological problems. Furthermore, PE may occur alongside other sexual conditions.1
There is strong medical evidence to support the use of oral medications in treating PE but these are only available on prescription.5 A doctor can provide information and advice on what is available.
Topical numbing creams or sprays
Creams and sprays containing anaesthetic compounds are available, which desensitise the penis and therefore help delay ejaculation.1,5 They have been successful for some men, however using topical anaesthetic for too long can overly numb the area leading to an inability to gain an erection or ejaculate.5 There is also the possibility of transferring the anaesthetic compound to a partner, which may reduce pleasurable sensations for them.
A number of do-it-yourself techniques exist that can help men to recognise pre-ejaculatory signs and improve their control over ejaculation, the most common are the ‘stop-start’ and ‘squeeze’ techniques.
- Masturbating before sex is one of the behavioural techniques which is often used to help manage premature ejaculation. This technique can be used to increase the amount of time it takes before ejaculation during sex, but this may not be a long term solution. Masturbating immediately before sex desensitises the penis, delaying ejaculation during sex.
- A number of men (around 41%) with premature ejaculation (PE) report using alcohol or recreational drugs to address their condition even though treatments are available.1 In the short term these all can delay ejaculation but in the long term they can cause PE. Serious undesirable side-effects associated with drugs must be taken into account. Moreover, psychological problems – developed as a result of dependence on other substances – could join the psychological problems caused by PE. Trying to ‘cure’ PE with drugs and/or alcohol can be very dangerous.