Premature Ejaculation May Not Be Related to Your Penis or Your Brain

If you're experiencing premature ejaculation, you've probably been told (even if only by Google) that it's due to either a psychological problem such as anxiety or an overly sensitive penis. Unfortunately, that is oversimplifying a complex issue. So buckle up, it's time for a lesson on the many physical and emotional causes that can result in orgasmic dismay.

An overview of PE

Premature ejaculation (PE)—climaxing during sex before you or your partner would like—is the most common form of sexual dysfunction in men, affecting about 30 percent worldwide. While there's no specific point at which a guy should orgasm, if you have PE, you probably feel you come way before you and your partner can enjoy lovemaking, whether that's before you even get going or just a minute or two into intercourse.

Premature ejaculation is challenging for multiple reasons. It can put a strain on your sex life and relationships, your self-confidence may take a hit and you can experience anxiety about having sex, which only exacerbates the problem. Your mental health, on the whole, may suffer—PE has been associated with an increased risk of anxiety and depression.

The many causes of early ejaculation

Premature ejaculation can result from a variety of mental health issues: generalized anxiety disorder, depression, stress, PTSD, sexual abuse or assault, guilt about sex, poor body image, relationship problems, unrealistic expectations about sex or another behavioral condition. Something as simple as overexcitement, overstimulation or novelty of a relationship can also trigger an early finish. As mentioned, anxiety about possibly climaxing quickly can, unfortunately, cause it to happen.

Yet while it's commonly believed premature ejaculation is all in your head, numerous physical conditions may be behind coming too early. One such factor is the most obvious: sensitivity. An overly sensitive penis may be more quickly stimulated, decreasing the time before ejaculation. But studies are mixed regarding the association between penile sensitivity and PE. Certainly, sensitivity gets a lot more blame than it deserves for causing widespread orgasmic problems when, in reality, other medical conditions are more likely the cause.

Abnormal hormone or neurotransmitter levels can play a role. Low levels of serotonin can cause the central nervous system to decrease the time to orgasm. Ejaculation issues may also be linked to sleep-cycle disturbances, excessive caffeine, poor diet or lack of sunlight exposure and vitamin D. A 2017 study published in the International Brazilian Journal of Urology, which evaluated ejaculation in 102 sexually active males, found levels of luteinizing hormone, prolactin and thyroid-stimulating hormone were all significantly lower in men with PE.

Chronic conditions have been associated with PE. Diabetes, for example, may lead to PE due to poorly controlled blood sugar levels, which impact the autonomic nervous system's control over sexual arousal. Thyroid problems could also contribute. The Sexual Medicine Society of North America found hyperthyroidism increased the risk of climaxing early. Prostate or urethra inflammation or infection can be a trigger; treating related PE could be as simple as curing a urinary tract infection (UTI) with antibiotics. Serious medical causes include prostate disease, cancer or multiple sclerosis.

Erectile dysfunction (ED), which can be caused by age, diabetes, heart disease and its risk factors (hypertension, clogged vessels, obesity), tobacco use, medications and low testosterone, is strongly associated with PE. Problems with ED should be treated first, as PE may subside afterward. Premature ejaculation can even be related to certain inherited genes. And just as with ED, drug use and excessive alcohol consumption can cause early climax—neither are friends to your penis or your sex life.

Implications for treatment

Premature ejaculation is a huge bummer, but don't go blaming it on your penis or your brain before ruling out other medical issues. The initial step in treating premature ejaculation is a doctor's evaluation to confirm the diagnosis and rule out or treat underlying medical causes.

Some cognitive-behavioral medications used to treat PE can impact serotonin levels, including selective serotonin reuptake inhibitors, or SSRIs (fluoxetine, sertraline, paroxetine); clomipramine, a tricyclic antidepressant; and tramadol, a pain management medication.

If sensitivity is contributing, your doctor might prescribe numbing creams and sprays. They can also discuss behavioral changes to combat PE, such as the squeeze method and start-stop method, both of which can help you last longer and improve enjoyment and satisfaction during sex. Masturbating several hours before sex and engaging in positions that help you come less quickly can also help.

If no underlying medical issue is found, speaking with a behavioral health professional can highlight any contributing mental health factors. Psychological therapies, such as cognitive behavioral therapy (CBT), can be beneficial. In the end, getting out of your head and getting the help you need may be the key to a more satisfying sex life.