Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 5/2/2022
If you’re one of the tens of millions of American men affected by premature ejaculation (PE), you may have wondered what causes your symptoms.
Experts aren’t completely aware of what causes premature ejaculation. However, research does suggest that it’s at least partly mental in nature, with issues such as anxiety, depression and low self-confidence common risk factors.
The good news is that premature ejaculation is almost always treatable, even when it’s linked to a mental health issue.
Below, we’ve explained what premature ejaculation is, as well as how your psychological health may play a role in the development of PE.
We’ve also discussed what you can do to successfully treat premature ejaculation and improve your sexual function, from psychotherapy to over-the-counter products, prescription medication and more.
Premature ejaculation is a common form of sexual dysfunction that affects around 30 percent of all adult men. It’s occasionally referred to as rapid ejaculation and is generally thought of as the most common male sexual performance issue.
Clinical definitions of premature ejaculation can vary. The DSM-5 defines premature ejaculation as ejaculation that occurs during sexual activity within approximately one minute of vaginal penetration, before the individual wants it, and without a clear medical explanation.
It’s normal to sometimes reach orgasm and ejaculate earlier than you’d like to during sex. To be defined as premature ejaculation, this issue normally needs to occur almost every time you and your partner have sex and cause clinically significant distress.
Premature ejaculation varies in severity. Some men have mild PE, meaning they’re able to have sex for 30 to 60 seconds before ejaculating. For others, PE is a severe problem that may lead to ejaculation at the start of sexual activity or before penetration.
Our guide to premature ejaculation goes into more detail about the most common symptoms of PE, as well as how they may affect you if you’re prone to this sexual function issue.
Researchers still don’t know precisely what causes premature ejaculation. However, the current research suggests that certain emotional and psychological factors appear to play at least some role in its development. These include:
Depression. Depression and sexual issues, including PE, are closely linked. In a review and meta-analysis published in 2016, researchers found that men with depression were significantly more likely to develop PE than their mentally healthy peers.
Common types of depression include major depressive disorder, persistent depression, seasonal affective disorder and depression with atypical features.
Anxiety. Feelings of anxiety may play a role in the development of PE. In a 2014 study, researchers found a clear link between anxiety, specifically sexual performance anxiety, and premature ejaculation.
Stress. Experts believe that stress contributes to premature ejaculation. Stress is also closely linked to other sexual functioning issues — for example, it’s a widely recognized risk factor for erectile dysfunction (ED).
Unrealistic expectations about sex. PE may be caused or worsened by unrealistic and irrational expectations about sexual pleasure or performance. However, some research suggests that there isn’t a strong link between porn use and PE.
Feelings of guilt. Feeling guilty about sex or certain types of sexual behavior can have a negative effect on your sexual performance. Not only is feeling guilty about sex a major factor for premature ejaculation, but it’s also linked to erectile dysfunction.
Lack of self-confidence. Experts believe that a lack of self-confidence and a poor body image may be risk factors for PE. You may be more likely to experience PE if you find it difficult to feel comfortable and relaxed during sex.
Relationship problems. Some relationship difficulties may affect your sexual health and increase your risk of experiencing PE. The stress involved in dealing with PE may also contribute to sexual dissatisfaction and problems in your relationships.
Prior sexual abuse. Traumatic or abusive events from your sexual history may increase your risk of developing premature ejaculation.Traumatic experiences are also linked to mental health issues in adulthood, including depression.
Several biological factors are also involved in premature ejaculation, including changes in levels of certain hormones and inflammation or infection that affects the urethra and/or prostate.
Premature ejaculation can be extremely frustrating to deal with, especially when it takes a toll on your sexual intimacy, satisfaction and ability to maintain a sexual relationship.
Whether your premature ejaculation is caused by a psychological or physical health issue, it can be treated.
Treatment for PE ranges from therapy to address underlying mental health issues to behavioral techniques, over-the-counter products and even prescription medication. We’ve covered these treatment options below and shared how each can help to improve your sexual performance.
When premature ejaculation is caused by negative thoughts, emotions or mental health issues such as anxiety or depression, psychotherapy can often help.
Psychotherapy, or talk therapy, involves identifying negative emotions, thoughts and behaviors, then taking steps to modify them. It’s something that you can do privately with a mental health provider or with others in a support group setting.
Taking part in therapy can help you to feel less anxious about having sex and provide additional confidence in the bedroom. It can also help with any psychological issues that are made worse or caused by premature ejaculation.
However, research is mixed on its efficacy as a treatment for PE itself. In order to be effective, it requires strong compliance and a significant time commitment. There’s also some evidence that its effectiveness may decrease with time.
To improve your results from therapy, your mental health provider may prescribe medication for you to use at the same time. We’ve discussed medications for PE in more detail below.
If your premature ejaculation is related to a mental health issue, such as an anxiety disorder or clinical depression, your mental health provider may prescribe medication to treat your mental health symptoms.
Over the years, several behavioral techniques have been developed to slow down orgasm and ejaculation in men with PE. These include precoital masturbation, the “squeeze” technique and the “stop-start” technique.
Precoital masturbation, as its name suggests, involves masturbating to orgasm before you plan to have sex. This method takes advantage of your refractory period, during which you may find it harder to ejaculate again. However, there’s little data about its effectiveness.
The squeeze technique involves squeezing around the glans (head) and shaft of your penis as you feel orgasm and ejaculation approaching. This can lower your desire to ejaculate and may help to prolong sex.
The stop-start technique involves stopping stimulation when you feel the sensation or orgasm approaching. Like the squeeze technique, it’s a simple approach to dealing with PE that you can use with your partner during sex, either on its own or with other treatments.
Premature ejaculation is often treated using desensitizing medications that are applied directly to your penis. These products are available as sprays, creams and wipes and typically contain topical anesthetics that reduce sensation.
For example, our Delay Spray for Men contains the anesthetic lidocaine, which helps to reduce sensitivity without overly numbing your penis.
While these products won’t treat the underlying psychological issues that may contribute to PE, they can provide a valuable confidence boost by delaying the onset of ejaculation and making it easier for you to perform in bed.
In one recent study, researchers found that a lidocaine spray produced significant increases in intravaginal ejaculatory latency time (IELT, or mean time to ejaculation) and frequency of sex in men affected by PE.
Our guide to lidocaine spray for premature ejaculation goes into more detail about how topical PE treatments work, how to use them, potential side effects and more.
Although there isn’t yet any FDA-approved medication specifically for PE, several medications are used off-label as PE treatments.
These medications work by increasing the amount of serotonin in your brain and body. Experts believe that premature ejaculation may be caused by low levels of serotonin, which shortens the amount of time required to ejaculate.
Most SSRIs used to treat PE need to be taken daily. It may take two to three weeks before you experience improvements in control over ejaculation from these medications.
Research shows that many SSRIs work well as treatments for PE. For example, a review and meta-analysis of the medication sertraline found that it increases average ejaculation time and sexual satisfaction in men with premature ejaculation.
We offer sertraline for premature ejaculation online, following a consultation with a healthcare provider who will determine if a prescription is appropriate.
Although researchers aren’t yet aware of exactly what causes PE, most research suggests that it’s at least partly psychological in nature.
A variety of mental health issues can act as risk factors for PE, including anxiety, severe stress, depression and low self-esteem. Certain thoughts and behaviors related to sex, such as a lack of confidence or unrealistic expectations, may also play a role.
If you have premature ejaculation and think a psychological issue may be involved, you should consider talking to a mental health provider.
You can do this by asking your primary care provider for a referral, or from home via our online mental health services. You can also access evidence-based medication for PE with our range of premature ejaculation treatments.
With the right combination of mental health care and medication, it’s absolutely possible to get your PE under control and enjoy a satisfying, fulfilling sex life.