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Is Premature Ejaculation Mental?

Kelly Brown MD, MBA

Reviewed by Kelly Brown, MD

Written by Shannon Ullman

Published 05/01/2022

Updated 03/05/2024

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.

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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:

Depression

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.

The most 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 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.

Stress

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).

Guilt

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.

Unrealistic Expectations About Sex

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.

Lack of Self-Confidence

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.

Mental Health Treatment

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.

Behavioral Techniques

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.

Check out our guide on how to hold ejaculation to discover more ways to stop premature ejaculation.

Over-the-Counter PE 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.

Prescription PE Medications

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.

The most common prescription medications for PE are SSRIs, including Prozac® (fluoxetine), Zoloft® (sertraline ), Paxil® (paroxetine), Lexapro® (escitalopram) and others.

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.

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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.

10 Sources

  1. Crowdis, M. (2023, May 30). Premature ejaculation. StatPearls - NCBI Bookshelf. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK546701/
  2. El‐Hamd, M. A. (2020). Effectiveness and tolerability of lidocaine 5% spray in the treatment of lifelong premature ejaculation patients: a randomized single-blind placebo-controlled clinical trial. International Journal of Impotence Research, 33(1), 96–101. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/31896832/
  3. Rajkumar, R. P. & Kumaran, A. K. (2014). The association of anxiety with the subtypes of premature ejaculation. The Primary Care Companion for CNS Disorders. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318671/
  4. Raveendran, A. V. & Agarwal, A. (2021). Premature ejaculation - current concepts in the management: A narrative review. Iranian Journal of Reproductive Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851481/
  5. Rowland, D. L. (2011b). Psychological impact of premature ejaculation and barriers to its recognition and treatment. Current Medical Research and Opinion, 27(8), 1509–1518. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/21663497/
  6. Psychotherapies. (n.d.). National Institute of Mental Health (NIMH). Retrieved from: https://www.nimh.nih.gov/health/topics/psychotherapies
  7. Symptoms & Causes of Erectile Dysfunction. (2022, August 29). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from: https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
  8. Saleh, R., Majzoub, A. et al. (2021). An update on the treatment of premature ejaculation: A systematic review. Arab Journal of Urology, 19(3), 281–302. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451625/
  9. Xia, Y., Li, J. et al. (2016). Relationship between premature ejaculation and depression. Medicine, 95(35), e4620. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008563/
  10. Zhang, Y., Chen, S. et al. (2019). Efficacy and safety of sertraline for the treatment of premature ejaculation. Medicine, 98(23), e15989. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571276/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown, MD

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown is a founding member of Posterity Health where she is Medical Director and leads strategy and design of their Digital Health Platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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