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Causes of Premature Ejaculation

Psychological, Behavioral, and Biological Causes of Premature Ejaculation


There is no known cause for premature ejaculation. But, there are a lot of myths about premature ejaculation, several theories, and a growing number of studies trying to determine what are probably the multiple factors that contribute to premature ejaculation.

Historically, the primary cause of premature ejaculation was thought to be psychological, and treatment for premature ejaculation focused on behavioral and psychological interventions. Since the 1980s, researchers have begun in earnest to look at biological factors that may influence premature ejaculation. This search has been intensified following the billion-dollar introduction of Viagra and the realization on the part of pharmaceutical companies that sex drugs for men were a gold mine.

Despite the myth that male sexuality is simple, sort of like an on/off switch, it seems increasingly likely that for many men, premature ejaculation is caused by multiple factors both physical and psychological. Here are some common theories as to what can cause premature ejaculation.

Behavioral Causes of Premature Ejaculation

From an evolutionary perspective, sex should be quick. After all, if sex is for procreation, the faster you get it over with, the sooner you’ll be able to retreat to a safe place or try and have sex again. I’m not a fan of such simplistic explanations but evolutionary psychologists do argue that premature ejaculation has an evolutionary component and is only a problem now because our goals for sex have changed.

A more direct behavioral cause for premature ejaculation suggests that in some ways, men may condition themselves to premature ejaculation based on their earliest sexual experiences. For many men, these experiences with masturbation or partner sex are done secretly and quickly, for fear of being discovered. In these situations, being able to ejaculate quickly is a “good” thing. It’s possible that early experiences may condition some men’s sexual response to a pattern of rapid ejaculation that they never get out of.

Psychological Causes of Premature Ejaculation

From a developmental perspective, premature ejaculation may be “caused” simply by a lack of education. Ejaculation is, among other things, a reflex. Children are taught to learn the signs of other reflexes and exert control over them this way. For example, we’re taught how to control urination at an early age. However, young men aren’t taught to control the ejaculatory reflex, and it’s not something talked about in most adult sexual health educator either. Techniques can be taught to control premature ejaculation. And for many men, once they learn these techniques the problem goes away.

It’s likely that almost all men will experience premature ejaculation at some point in their lives. It becomes a problem when it is ongoing, and a major culprit for this is performance anxiety. If a man is concerned about the timing of ejaculation (often talked about as worrying about how he will “perform”), this concern can easily become anxiety, which can actually increase the chances that he will ejaculate before he wants to. In this way, anxiety fuels a vicious cycle for men who premature ejaculate.

Biological Causes of Premature Ejaculation

There are several theories about biological causes of premature ejaculation.

If premature ejaculation results from too much genital arousal, one theory is that men who ejaculate prematurely have more sensitive genitals. Research on this cause is conflicting. Some studies have shown men who experience premature ejaculation score higher on genital sensitivity exams. But others have shown no significant difference between men who ejaculate prematurely and those who don’t when examined and tested for genital sensitivity.

The hormone testosterone has been linked to ejaculation and some researchers suspect that hormone levels may play a role in control over ejaculation. This is a possible cause that is just now being explored through research.

A few papers and at least one (small) study have examined the link between hyperthyroidism and premature ejaculation. The study, which only looked at 43 men, reported that 72% of the men with hyperthyroidism experienced premature ejaculation. The exact reason why excess thyroid hormone would cause premature ejaculation is unknown, and much more research is needed in this area. But if you have hyperthyroidism and experience premature ejaculation, it may be something to talk to your doctor about.

Studies of erectile dysfunction in men with diabetes suggest that anywhere from 35% to 90% of men with diabetes experience some form of erectile dysfunction. There is some indication that in addition to erectile dysfunction, men with diabetes may be at increased risk of premature ejaculation. The exact causes are not yet known, and most research suggests that living with diabetes could present multiple factors that increase the chances of premature ejaculation.

Medications that May Cause Premature Ejaculation

Not many medications are known to cause premature ejaculation as a side effect. Phenylopropanolamine, which is no longer available in the U.S., is a decongestant that was used as a weight-loss drug and was thought to cause or worsen premature ejaculation. It has also been reported that one of the withdrawal symptoms experienced by people who go off the drug trifluoperazine is premature ejaculation.


Cihan, A., Demir, O., Demir, T., et. al. “The Relationship Between Premature Ejaculation and Hyperthyroidism” The Journal of Urology Vol. 181, No. 3 (2009): 1273-80.

Crenshaw, T.L. & Goldberg, J.P. Sexual Pharmacology New York: W.W. Norton, 1996.

Lasantha S.M., Shanthilal D.J., Samudra T.K., et. al. “Erectile Dysfunction Among Men with Diabetes is Strongly Associated with Premature Ejaculation and Reduced Libido” Vol. 5, No. 9 (2008): 2125-2134.

Malavige, L.S. & Levy, J.C. “Erectile Dysfunction in Diabetes Mellitus” Journal of Sexual Medicine Vol. 6, No. 5 (2009): 1232-1247.

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