Many men ask what is wrong with them when they ejaculate sooner than they want to. Usually the answer is not one thing. Premature ejaculation (PE) is linked with a mix of psychological, relationship and physical factors, and the mix differs from man to man. This page gives the overview. The pages linked below go into each cause in more depth.
In this section
01
Why there is rarely a single cause
The research on causes is still incomplete. The International Society for Sexual Medicine (ISSM) guideline lists several biological ideas, such as a more sensitive tip of the penis and differences in the way the nerve chemical serotonin works, but says none has been confirmed in large studies. It also says the effect of genes is small if it exists at all. So be wary of any website or product that claims to know the one cause and the one fix.
Another point from the guideline is that cause and effect often run in both directions. Worry about performance can lead to ejaculating quickly, and ejaculating quickly then increases the worry.
02
Psychological and relationship factors
Performance anxiety is the factor most often discussed. Stress, low mood, concerns about body image and strain in a relationship can also play a part. For some men these are the main driver. For others they make an existing tendency worse. The guideline notes that how much each of these causes PE has been studied only a little, so they are better described as contributors than as proven causes.
Read more: anxiety and performance pressure, and PE and your partner.
03
Biological and medical factors
Erectile problems
acquired PE is associated with erectile dysfunction. Some men ejaculate quickly because they are anxious about losing an erection, or because they rush. Men who have both tend to have more severe PE and respond less well to treatment.
Thyroid conditions
an overactive thyroid has been linked to acquired PE in a small number of men, and in some reports the problem eased once thyroid levels were normal. No link has been found with lifelong PE.
Prostate inflammation and pelvic pain
between about a quarter and three quarters of men with chronic prostatitis or chronic pelvic pain report ejaculating early. Nobody is certain why.
Medicines and other substances
some medicines and drugs can change ejaculation. Tell your clinician everything you take, including supplements.
Read more: medical causes of premature ejaculation.
04
Habits and lifestyle
Many men wonder whether masturbation habits, pornography, alcohol, sleep or fitness play a role. The evidence here is thin, and what exists is mixed. Nothing in the main guidelines lets us say that any of these causes PE. Read our page on masturbation, porn and premature ejaculation for what is known and what is not.
05
Lifelong versus acquired causes
Lifelong and acquired PE tend to have different explanations. Erectile problems and thyroid conditions are unlikely explanations for lifelong PE, while they come up more often when PE starts later in life. If your PE began after a period of normal timing, it is worth asking what changed. See the types of premature ejaculation.
06
What an assessment looks for
A clinician takes a history, not just a set of tests. They will ask when it started, whether it happens with every partner, how your erections are, what medicines you take and how stress and relationships are going. For acquired PE they may examine you and check for thyroid, prostate and erection problems. Routine blood tests are not needed for everyone. See our main guide for how assessment works.
07
Where to go next
If you are not sure which of these fits, try the private self-check or read when to see a doctor. The sections below link to the detailed cause pages.