What Causes Premature Ejaculation? Myths and Facts

Premature ejaculation is one of the most common sexual problems in men, yet out of embarrassment it is often not raised with a doctor. In most cases, however, the cause can be understood and treated. In this short guide we summarise the causes of premature ejaculation and what popular beliefs really mean.

What is premature ejaculation?

Premature ejaculation means that a man cannot delay ejaculation for as long as he would like, and that this causes distress, frustration or avoidance of sex for him or for the couple. Three elements are assessed together in the diagnosis:

• Ejaculation happening within a short time
• Inability to control ejaculation
• A negative effect on the man or the relationship

Occasional quick ejaculation, for example after a long break or with a new partner, does not on its own mean premature ejaculation.

What types of premature ejaculation are there?

• Lifelong premature ejaculation: Occurs in almost every sexual encounter from the very first sexual experiences.
• Acquired premature ejaculation: Appears after a certain point in a man who previously had no problems.
• Variable premature ejaculation: Occurs from time to time, at irregular intervals, and is often considered part of normal variation.
• Perceived premature ejaculation: The time is actually within normal limits, but the man perceives it as short. Here, expectations and a lack of information play an important role.

Identifying the type is important, because the causes and the treatment approach differ by type. In the lifelong type, treatments that support ejaculatory control in the long term come to the fore, while in the acquired type the underlying medical or psychological cause is investigated first. In the variable and perceived types, accurate information and counselling for the couple together are often enough.

What causes premature ejaculation?

The causes differ depending on the type of premature ejaculation.

Main causes in the lifelong type:

• A tendency in the nervous system that regulates ejaculation, particularly in the balance of serotonin
• Genetic predisposition
• Differences in penile sensitivity

Main causes in the acquired type:

• Erection problems: Rushing sex out of fear of losing the erection can lead to premature ejaculation. For this reason, the two conditions should be assessed together. For details, see the erectile dysfunction page.
• Inflammation of the prostate (prostatitis) and urinary tract infections
• Thyroid disease, particularly an overactive thyroid
• Performance anxiety, stress and depression
• Relationship problems and poor communication
• Stopping certain medicines or substances

Are the popular beliefs about premature ejaculation true?

• “Premature ejaculation is purely psychological.” False. Psychological factors can play a role, but biological causes are at least as important.
• “Masturbation leads to premature ejaculation.” There is no scientific evidence to support this.
• “Circumcision causes premature ejaculation.” This widespread belief is not supported by scientific studies.
• “Normal duration is what you see in films.” Adult films are not a realistic measure and can have a negative effect on expectations.
• “Premature ejaculation cannot be treated.” False. With appropriate methods, most men can achieve a marked improvement.
• “Herbal products bought online are safe.” The contents of these products may not be regulated, and they may contain undeclared active drug ingredients. They can pose a risk for people with heart disease or those who take regular medication.

How can premature ejaculation be told apart from erection problems?

These two conditions are often confused and sometimes occur together. Roughly, the distinction is as follows:

• In premature ejaculation, the erection is adequate, but ejaculation happens sooner than wanted and without control.
• In erectile dysfunction, an erection firm enough for sex cannot be achieved or maintained. The man may rush sex so as not to lose the erection, and this may be perceived as premature ejaculation.

If both problems are present, treatment usually starts with the erection problem. When the erection improves, ejaculatory control often improves as well.

How can a partner support the process?

Premature ejaculation affects not only the man but the couple together. Open communication without blame reduces anxiety and makes it easier to stick with treatment. Behavioural techniques can be more effective when the partner takes part. Not reducing sex to duration alone, and focusing on foreplay and mutual satisfaction, also helps the couple relax. If considered necessary, support from a sex therapist can be sought.

How is premature ejaculation assessed?

The assessment usually starts with a detailed conversation. You will be asked how long the problem has been going on, whether it happens every time, whether there are erection problems as well, and how your partner feels about it. In addition to a physical examination, a urine test, an assessment of the prostate and hormone tests may be requested if necessary.

Treatment may include behavioural techniques (the stop-start and squeeze methods), pelvic floor exercises, medicines the doctor considers suitable and, if necessary, couples therapy. In acquired premature ejaculation, treating the underlying cause comes first. For detailed information on treatment options, see the premature ejaculation treatment page.

When should you see a urologist?

It is advisable to see a urologist if you feel you cannot control ejaculation and this is affecting you or your relationship, if premature ejaculation has started recently when you previously had no problems, or if it comes with erection problems, burning when passing urine or pelvic pain. The consultation is confidential and non-judgemental; it can help if your partner joins the consultation as well.

Op. Dr. Mücahit Kabar sees patients in Bursa (Nilüfer), Turkey, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) and Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). Appointments are booked through the hospitals’ online booking pages or appointment lines. Consultations are held in English or Turkish; the hospitals’ international patient departments can arrange interpreters for other languages. For questions before your visit, you can send a WhatsApp message to +90 541 622 54 82. Further details are on the contact page.