What causes PE?

Premature ejaculation is a complicated condition. Whether it's physiological or psychological, it's never ideal. Here are the known causes, explained.

Written by
Luke Benedictus
Medically reviewed by
Dr Matthew Vickers
Last updated
May 30, 2022
4
min read
5
citations
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The sex life of the male rhesus macaque monkey is violent and chaotic. They regularly get it on with female monkeys in marathon sex bouts that 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 in order to return to their amorous pursuits.

Consequently, few macaques escape mating season without sustaining a few cuts and bruises.

Lawrence Hong, a sociologist from California State University, referred to the perils of the monkeys’ mating habits in Survival of The Fastest, a speculative essay on the origin of premature ejaculation.

The article, published in The Journal of Sex Research, points out that the original function of sex was primarily reproductive rather than recreational. Viewed from this evolutionary perspective, rapid ejaculation made sense as the most efficient way of spreading your seed and getting the job done.

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’re struggling with premature ejaculation, Hong’s views on your evolutionary competence are unlikely to prove much of a consolation. If you want to tackle the problem, then you have to understand the root cause.

Primary or acquired

“The main aspects of how we approach any initial consultation around PE is to establish a background of general health information,” says Dr Matthew Vickers, a Sydney GP. “That will have a considerable impact in terms of what we will prescribe and what is the underlying cause.”

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

“Primary” premature ejaculation is diagnosed if a man has suffered from the issue ever since they first began having sex. “Acquired” PE, on the other hand, is when the complaint suddenly emerges in a man’s sex life after a period where everything has previously been fine.

Physiological causes

The reason a doctor will want to establish an overview of your general health is there are a host of physiological reasons 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 PE 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 three times as likely to suffer from premature ejaculation than guys with smaller guts.

In addition, the researchers found that 51 per cent of men with PE met the criteria for “metabolic syndrome”, which they defined as experiencing three 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.

Drugs and booze

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 on men who were dependent on alcohol found that 72 per cent reported some form of sexual dysfunction with PE featuring high on the list.

In further bad news for the hedonistically inclined, recreational drugs can also interfere with your love life. An Australian study found that people who smoke cannabis on a daily basis are almost three times as likely to be “reaching orgasm too quickly”.

Psychological elements

Yet many cases of premature ejaculation also have some psychological element.

Cases of acquired PE, 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 PE 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.”

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

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

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 doctor can prescribe 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.”

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