Premature ejaculation (PE) is pretty darn common — it affects around 30 percent of men between the ages of 18 and 59 and is considered to be the most common sexual dysfunction problem among men. So, whether it’s you or your partner, you’re probably no stranger to this phenomenon.
Experts aren’t exactly sure what causes premature ejaculation, but research suggests that this male sexual disorder is partially a psychological issue. Problems like anxiety, depression, relationship issues and low self-confidence are all common risk factors for PE.
Fortunately, premature ejaculation is treatable, whether it’s caused by mental issues or underlying physical conditions.
To help you better understand the relationship between mental health and PE, we’ve explored how certain mental health conditions and other factors can lead to the development of this sexual issue.
We’ve also explored possible treatment options for premature ejaculation, all of which may help improve your sexual function and delay ejaculation.
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Before discussing the causes of mental premature ejaculation, let’s cover the basics of this sexual disorder.
PE is a type of sexual dysfunction disorder that occurs when you ejaculate much sooner than you’d like during sexual activity.
About 30 percent of men deal with premature ejaculation, but some research studies state that up to 75 percent of men can experience this condition.
Some PE can be temporary, but prolonged premature ejaculation that lasts for a year or more can potentially lead to depression, relationship problems and other issues.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association (APA) defines PE as ejaculation that occurs within one minute of vaginal penetration — before someone wishes to ejaculate — and without a clear medical explanation.
Let’s be clear: it’s not abnormal to reach orgasm and ejaculate earlier than you’d like to during sex. But what takes it from a normal thing all guys deal with sometimes to a potential concern is how often you lose ejaculatory control.
To be defined as premature ejaculation, this issue normally needs to occur almost every time you and your partner have sex, as well as 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.
So, is premature ejaculation mental, or something else completely?
As we’ve mentioned before, researchers aren’t quite sure why premature ejaculation arises. However, the current research suggests that emotional and psychological factors play at least some role in male sexual dysfunction.
The psychological causes of premature ejaculation may include the following:
According to a review and meta-analysis involving 18,035 male patients, those diagnosed with depression were more likely to develop PE than their mentally healthy peers. However, it is important to note that further research is necessary to get a better understanding of the connection between PE and depression.
Feelings of anxiety may play a significant role in the development of premature ejaculation during sexual intercourse. A small review of 28 male patients with premature ejaculation, for example, found that those with acquired PE (meaning that it starts later in life, after a period of normal ejaculatory function) have substantially higher rates of sexual performance anxiety.
If you get stressed often, it may contribute to sexual problems like premature ejaculation. Stress is commonly linked to other sexual functioning issues and is a widely recognized risk factor for erectile dysfunction (ED).
Feeling guilty about underperforming in the bedroom? Well, that might just be adding to the mental load. Not only is feeling guilty about sex a major factor for premature ejaculation, but it’s also linked to erectile dysfunction.
PE may be caused or worsened by unrealistic and irrational expectations about sexual pleasure or performance. If you put pressure on yourself to perform at a high level, that can lead you to a vicious cycle of PE and underperformance.
Low self-confidence and a poor body image might be risk factors for PE. In fact, you’re more likely to experience premature ejaculation if you’re having trouble getting comfortable and relaxed during sex.
Premature ejaculation can be extremely frustrating to deal with, especially when it takes a toll on your sexual intimacy, sexual satisfaction and ability to maintain a sexual relationship.
Luckily, treatment of premature ejaculation is possible, whether it’s caused by psychological conditions or by physical health issues.
Treatment for early ejaculation 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.
Psychotherapy, or talk therapy, involves identifying negative emotions, thoughts and behaviors and then taking steps to modify them. It’s something that you can do privately with a mental health provider, with your partner or with others in a support group setting.
Taking part in psychotherapy, or even sex therapy, can help you to feel less anxious about having sex and provide additional confidence in the bedroom.
However, research is mixed on its efficacy as a psychological treatment for PE itself. 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 increase the chance of therapy improving your sexual health, your mental health provider may prescribe medication for you to use at the same time. This is especially likely if your premature ejaculation is related to a mental health issue, such as an anxiety disorder or clinical depression.
These medications might include selective serotonin reuptake inhibitors (SSRIs), other antidepressants or anti-anxiety medications such as benzodiazepines and buspirone. We’ll cover more about these after we talk about some other treatments.
Several behavioral techniques have been developed to help slow orgasm and ejaculation for men with PE. These techniques are precoital masturbation, the “squeeze” technique and the “start-stop” technique.
Precoital masturbation involves masturbating to orgasm before having sex with your partner(s). Using this method takes advantage of your refractory period, which is the period when it can be difficult to ejaculate again. However, we’d like to mention that there’s little data about its effectiveness.
Then there’s the squeeze technique, which involves squeezing around the glans (head) and the shaft of your penis as ejaculation nears. This method can reduce your desire to ejaculate, making your sex last longer.
Last but not least is the stop-start technique. For this method, you’ll stop stimulation once you feel the sensation of orgasm approaching. Like the squeeze technique, it’s a simple way to deal with premature ejaculation during sex. You can try it by itself or in combination with other treatments.
There are several over-the-counter treatments for premature ejaculation, which work by desensitizing your penis. These sprays, creams and benzocaine wipes are topical treatments that you apply directly to your penis to reduce sensation.
For example, our Delay Spray for Men contains the anesthetic lidocaine, which helps to reduce sensitivity without overly numbing your penis.
Research shows that lidocaine spray can significantly increase 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.
Now let’s be clear — these products likely won’t be the end-all-be-all for premature ejaculation. They can address physical symptoms of PE to increase sexual performance, but they won’t help with any psychological issues tied to your sexual dysfunction.
If all else fails, it’s time to talk to your healthcare provider about prescriptions for mental premature ejaculation.
There currently aren’t any PE medications approved by the Food and Drug Administration (FDA), but several medications are used off-label as PE treatments.
These medications work by increasing the amount of serotonin in your brain and body. Researchers believe that premature ejaculation may be caused by having low levels of serotonin, which shortens the amount of time required to ejaculate.
You can expect to take these medications daily for optimal results. It can take two to three weeks before you begin to notice improvements in controlling your ejaculation.
And, in case you still aren’t sure about the effectiveness of SSRIs for mental premature ejaculation, know that we’ve done our homework.
Research shows that many SSRIs work well as treatments for PE. A review and meta-analysis of the medication sertraline, for example, 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. Premature Ejaculation.
While we still don’t know exactly what causes PE, we do know that it may be linked to psychological issues for many men. If you have premature ejaculation, it’s crucial to seek medical care to ensure you’re fully addressing all aspects of your sexual dysfunction disorder.
While you’re seeking help, keep these facts in mind:
Premature ejaculation is common. Premature ejaculation happens to about 30 percent of all adult men, but the exact cause is unknown.
PE may be tied to mental health. There has been a lot of research that links a variety of psychological and emotional factors to PE. Conditions such as depression, performance anxiety, stress, guilt, unrealistic expectations about sex and lack of self-confidence can all lead to premature ejaculation.
Be open with your healthcare provider about PE concerns. It is important that you work with your healthcare provider and have an honest conversation. This will help them figure out the underlying cause of your PE and create a treatment plan for you.
PE looks different for everyone. Remember that not all PE is the same — which means the same treatments might not work for everyone. Be open to trying a few things to find the right treatment for you.
If you have premature ejaculation and think a psychological issue may be involved, you should consider talking to a mental health provider.
You can ask your primary care provider for a referral or talk to a professional from home via our online mental health services. You can also access our range of premature ejaculation treatments, including evidence-based medications.
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Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.