What causes PE?

Premature ejaculation is a complicated condition — here are the known causes, explained.

Written by
Luke Benedictus
Medically reviewed by
Dr Matthew Vickers
Last updated
May 15, 2024
min read
What causes PE?
Jump to:

An often awkward and challenging topic to discuss, opening up about premature ejaculation can be very intimidating. But it can also be viewed as an evolutionary adaptation. Let's take a look at this through the lens of a monkey.

The sex bouts of the male rhesus macaque monkey can last for over an hour. But the length of their intercourse comes at a dangerous cost.

Sex becomes so time-consuming the monkeys are frequently interrupted mid-thrust by attacks from rival males, who they then have to fight off to return to their sexual pursuits. Consequently, few macaques escape mating season without sustaining a few cuts and bruises.

Lawrence Hong, a sociologist from California State University, points out in his essay, Survival of The Fastest [1], that the original function of sex was primarily reproductive rather than recreational. Therefore, rapid ejaculation made sense as the most efficient way of spreading your seed.

For that reason, Hong argues, our caveman ancestors evolved to fornicate as quickly as possible, so they “were less likely to be repelled by the females and/or attacked by other sexually aroused males”.

In fact, he suggests, premature ejaculation may only have developed negative connotations in recent times as sex became less focused on procreation and more on pleasure.

Unfortunately, if you experience premature ejaculation during sexual intercourse, Hong’s views on your evolutionary competence are unlikely to prove much of a consolation. If you want to tackle the problem of PE, then you'll have to understand what causes premature ejaculation and the root cause of yours.

Here are the known causes and the answers on how you can treat premature ejaculation, explained.

Primary vs acquired premature ejaculation

“The main aspects of how we approach any initial consultation around premature ejaculation is to establish a background of general health information,” says Dr Matthew Vickers, a Sydney GP. “This has a considerable impact in terms of what a practitioner will recommend and what is the underlying cause.”

During that first appointment, your practitioner will be trying to classify whether your form of premature ejaculation is “primary” or “acquired”.

Primary premature ejaculation, otherwise known as lifelong premature ejaculation, is diagnosed if a man has suffered from early ejaculation ever since he first began having sex. On the other hand, acquired premature ejaculation develops when the complaint suddenly emerges in a man’s sex life after a period where everything has previously been fine.

Causes of premature ejaculation

There are a number of factors that play into premature ejaculation. Here's what you need to know.

Physiological causes

The reason a doctor will want to establish an overview of your general health is there are a host of physical factors that could be contributing to your issue. “Premature ejaculation can sometimes be the first sign of issues like heart disease or diabetes,” Dr Vickers says.

“We also know that some medications can cause erectile dysfunction, so it's important that we get a full history in terms of what medical conditions people have, their surgeries, and what medications they're taking.”

If the cause of your premature ejaculation is physiological, weight gain is one potential cause. A study in the International Journal of Impotence Research found that men with a waist measurement above 40 inches were more than 3 times as likely to suffer from premature ejaculation than guys with smaller guts.

In addition, the researchers found that 51% of men with premature ejaculation met the criteria for “metabolic syndrome”, which they defined as experiencing 3 of the following issues: high blood pressure, high blood sugar, a waist circumference above 40 inches, low HDL (often known as “good cholesterol”), and elevated blood triglycerides.

To address the concerning health implications of weight gain, Pilot's Metabolic Reset Program was created — to help you tackle weight loss and achieve a healthy weight in a way that works with, not against, your body thanks to the combination of modern medicines, one-on-one goal setting, health coaching and biometric tracking with your Pilot practitioner.

Backed by dieticians, doctors and endocrinologists, the program works to sustainably reset the body’s metabolic patterns with the ongoing support of a health coach.

In other good news, exercise can have positive effects in reducing premature ejaculation and improving your sexual experience. Kegel exercises strengthen the pelvic floor muscles needed to help you build sex stamina and delay ejaculation.

Exercises such as the start and stop method and the squeeze technique can decrease sensation taking, prevent premature ejaculation and help you last longer in bed. Changing your diet to include foods such as those rich in zinc and magnesium may also have a major impact on preventing and treating premature ejaculation.  

Drugs and alcohol

Other lifestyle factors can also impact how long you last in bed. Heavy drinking, for example, can often have a disruptive influence on your love life. One study of men who were dependent on alcohol found that 72% reported some form of sexual dysfunction with premature ejaculation featuring high on the list [2].

In further bad news for the hedonistically inclined, cigarette smoking and recreational drugs are risk factors when it comes to your love life. An Australian study found that people who smoke cannabis on a daily basis are almost 3 times as likely to be “reaching orgasm too quickly” [3].

Psychological elements

Many cases of premature ejaculation have some psychological element. Cases of acquired premature ejaculation, Dr Vickers explains, are “most commonly due to erectile dysfunction”.

This can have a regrettable knock-on effect as, not surprisingly, struggling to maintain an erection can then lead to performance anxiety during sex.

“The reason why premature ejaculation sometimes develops after erectile dysfunction is due to a brain reflex,” says Dr Vickers. “The obvious goal of sexual activity is to ejaculate for reproduction. So with men who’ve suffered erectile dysfunction, the brain can take over and force the body to ejaculate before they lose their erection completely.”

Medical help is available to treat erectile dysfunction — Pilot is a discreet way to secure a personalised erectile dysfunction treatment plan from our Australian practitioners. These treatments work by targeting the enzyme that is responsible for the contraction of blood vessels in the penis. By preventing this enzyme from working, it can relax the blood vessels in your penis and increases blood flow, which helps with achieving an erection.

It’s not just performance anxiety that leads to problems in the trouser department. One survey of 789 men found that premature ejaculation was frequently associated with heightened anxiety levels in general. 

“Premature ejaculation is commonly associated with psychological causes (e.g. anxiety disorders, stress, interpersonal conflicts, guilt and fears),” reads an article in BJUI International, a urology-focused medical journal. “These problems are very real.”

Other symptoms such as sexual abuse, poor body image and depression can also play a role. It is worth pointing out that premature ejaculation can occur with a new sexual partner as well as due to relationship problems, whereby tension in bed can cause performance anxiety.

If you're looking for someone to talk to about any emotional issues, consider seeking the help of a mental health professional. Pilot has partnered with This Is A Conversation Starter (TCIAS) to offer free early-intervention, short-term mental health counselling. Everyone's welcome and no GP referral is required.

But, while it’s tempting to try and zero in on a single cause, Dr Vickers admits that premature ejaculation usually results from a combination of factors.

“In most cases, there's an element of both the psychological and physiological,” he says. “And the evidence shows that the best form of treatment is often a mix of behavioural and psychological techniques combined with medication.”

The complexity of premature ejaculation means that it’s always worth getting professional help to pinpoint the specific cause of your problem. Once that’s been identified, a practitioner can create a relevant course of action to boost your staying power and improve your sex life.

“Premature ejaculation is something that is prevalent and very undertreated,” Dr Vickers says.

“A lot of that is because of the stigma and embarrassment around the condition. But men should be aware that there is treatment available that can help them.”

This is where we come in. Pilot’s Last Longer, Naturally program, developed by sex coach Georgia Grace and sexual health specialist Dr Michael Lowy, teaches you how to last longer in just 4 weeks.

Designed to address the psychological factors and habits of premature ejaculation with behavioural training, it includes everything you need to master ejaculation control.

Plus, Pilot also offers clinical treatment plans for PE. The daily or on-demand treatments are fast-working and 74% of patients report improvements when using these. There's no shame in reaching out for help to treat premature ejaculation.


  1. DOI: 10.1080/00224498409551212
  2. PMC2917074
  3. https://www.jsm.jsexmed.org/article/S1743-6095(15)32873-3/fulltext 
See all
Articles you might like:
No items found.
Give this a go:
Delay Device Bundle
$ 149.00 
Performance in bed is trainable. Pilot's Control Device with our expert video classes teaches long-lasting climax control. Improve your sex life today.
Read more
Last Longer Complete Bundle
$ 199.00 
Performance in bed is trainable. Pilot's Control Device with our expert video classes teaches long-lasting climax control. Paired with our delay gel and lubricant.
Read more
Give this a go:
Delay Device Bundle
$ 149.00 
Performance in bed is trainable. Pilot's Control Device with our expert video classes teaches long-lasting climax control. Improve your sex life today.
Delay Device Bundle
Last Longer Complete Bundle
$ 199.00 
Performance in bed is trainable. Pilot's Control Device with our expert video classes teaches long-lasting climax control. Paired with our delay gel and lubricant.
Last Longer Complete Bundle
Real men, real results
No items found.
No items found.

All the tools, delivered

Get a round-up of top reads, new launches, and exclusive offers.
You’ve been subscribed!
Oops! Something went wrong while submitting the form.
T-Support One Off
T-Support One Off
$ 55.00 
Daily supplement packed full of essential vitamins and minerals to support the production of testosterone.