Is your premature ejaculation psychological, physical or both? Furthermore, do you know if it is acquired or lifelong premature ejaculation?
Your mind is powerful. Very powerful. Except in this instance, it’s letting you down. Literally.
You thought this was a young man problem. All you needed to do is get more experience and you will be able to control your emotions and your ejaculation.
But it’s only getting worse.
You decide you MUST do something. But what?
The premature ejaculation treatment plan you should take depends if your premature ejaculation is physical, psychological or both.
Premature Ejaculation: Is it all in your brain?
Not necessarily. It’s complicated, very complicated. Male sexual function is divided into five stages:
Sexual intercourse (insertion of an erect penis into a body cavity)
Orgasm. Attaining erections and controlling ejaculations appear to be the source of most sexual problems amongst men.
Many men’s health experts have questioned whether premature ejaculation is purely psychological.
The most common sexual disorder in men under the age of 40 is premature (early) ejaculation (PE) and affects 30-70% of males in the United States at some point in their lives. It has been considered a psychological disease in the past but recent findings indicate a sensory or neurologic basis may be part of the problem.
Do I have acquired or lifelong premature ejaculation?
Among the patients with PE, the final diagnosis was lifelong premature ejaculation for the vast majority of them, regardless of whether they thought they had the acquired form. Several of those who sought help for acquired PE were largely found to be able to compensate for their lifelong PE with an eventual episode of sex or were able to induce orgasm in their partner with different techniques. Overall, 18.5% of those with low desire had a very sensitive penis and 23% had ED .
An occasional episode of PE may occur and is of no consequence. The diagnosis is usually made when the PE occurs in 50% or more of sexual attempts. On the other hand, the condition may be based on both partners assessment that the ejaculation occurred earlier than wished rather than an absolute duration of time.
What are the mechanics of premature ejaculation?
The process of sexual intercourse is quite complex. Nerves, muscles, blood flow, brain, and connective tissue must all respond in a synchronized fashion to get the job done. At any point in the process, difficulties may arise .
The process of ejaculation is influenced by the brain or central nervous system (CNS). Many neurotransmitters are involved such as dopamine, norepinephrine, serotonin, GABA, acetylcholine, oxytocin, and nitric oxide. However, dopamine and serotonin are the two essential neurochemical factors, with dopamine helping ejaculation and serotonin inhibiting ejaculation.
There are three phases of ejaculation
Emission is the first stage where semen is excreted into the urethra passing through the prostate under the control of the hypogastric nerve
2. Ejection (Expulsion)
The pudendal nerve causes the periurethral, the bulbocavernosus, and the pelvic floor muscles to contract rhythmically, ejaculating semen from the tip of the penis. At the moment of ejection, the urinary sphincter of the bladder closes so that semen does not reflux back to the bladder.
At the same time as ejaculation, the pressure in the spongy tissue of the penis stimulates the brain centre (via the pudendal nerve) to create an enjoyable sensation.
Ejaculation dysfunction or EjD is caused by a failure of any of these ejaculation mechanisms.
Definition of Premature Ejaculation: Psychological Edition.
PE is defined by a sexual life that is negatively affected, such as pain, annoyance, frustration, and avoidance of sexual intimacy for the person or partner . It can be situational (specific partners or circumstances) or generalized.
Lifelong Premature Ejaculation
In the case of lifelong premature ejaculation, intravaginal ejaculation happens within 1 minute from the time of first sexual intercourse. Possible causes may be a decreased sensitivity of serotonin 5‐HT2C receptors and serotonin 5‐HT1A receptors are increased and other theories concerning genetic factors. The premature ejaculation treatment for lifelong PE is often a combination of oral medication and therapy.
Acquired Premature Ejaculation
With acquired type premature ejaculation, intravaginal ejaculation gradually decreases to 3 minutes or less as time goes on. It can be caused by diseases such as erectile dysfunction (ED) and prostatitis, hyperthyroidism, or psychological factors or relationships with partners.
What is worse: Psychological or physical premature ejaculation?
In many cases, psychological premature ejaculation is harder to treat however both psychological and physical premature ejaculation can vary in severity.
Premature ejaculation treatment will vary depending on the cause however in most cases your GP or PE expert will advise on a combination of medication and psychological therapy.
The longer any type of premature ejaculation is left without intervention the harder it is to treat. For this reason premature ejaculation treatment is advised within 6 months of noticing the symptoms.
The severity of premature ejaculation is rated as follows:
Mild occurs within approximately 30 seconds to 1 minute of vaginal penetration
Moderate occurs within approximately 15-30 seconds of vaginal penetration
Severe occurs before sexual activity, at the start of sexual activity, or within 15 seconds of vaginal penetration
The Control Center for Ejaculation
Electroencephalography (EEG) is a test of the electrical activity in the brain and neuroimaging studies have detected abnormal spontaneous and provoked brain responses to erotic stimuli as well as brain structure changes in premature ejaculation patients. A study by Yang et al used functional magnetic resonance imaging (fMRI) and showed that patients with lifelong premature ejaculation had an abnormal brain control network, that may have contributed to the reduced ‘brain’ control of rapid ejaculation .
Likewise, a group of nerves in the lumbar spinal cord are possibly considered the spark for ejaculation. This nerve site is thought to be linked to dopamine pathways in the brain, which play significant roles in sexual behaviour. Other questions have been raised pertaining to the possible hormonal or biochemical components of premature ejaculation.
Testosterone is thought to play a role in the ejaculatory reflex. According to one study, there are higher free and total testosterone levels in men with premature ejaculation compared to men without premature ejaculation .
Research published in a Chinese journal showed that semen from men with premature ejaculation contained less acid phosphatase and alpha-glucosidase than did the semen of those without PE .The relevance of these findings have not been confirmed in subsequent studies.
Whereas biochemical markers (eg, prolactin)  may contribute to premature ejaculation, organic and psychological associations (eg, anxiety) suggest that hormonal or biochemical parameters play only a partial role.
Multiple investigators have found differences in nerve conduction/latency times and hormonal differences in men who experience premature ejaculation compared with normal individuals. The theory is that some men are hyperexcitable or have oversensitive genitalia that prevents the nerves from slowing down the electrical impulses to delay orgasm.
Psychological factors, while not the only reasons, have been found to contribute greatly to premature ejaculation as demonstrated by studies that found a positive correlation of psychiatric diagnoses in men with PE 
Potential Other Causes of PE
One psychological explanation for premature ejaculation is that males, as teenagers, are conditioned during masturbation or other sexual activities to reach climax quickly because of fear of discovery. This quick sexual climax pattern makes it is difficult to reverse and relationships can suffer.
There is an increased knowledge about female arousal and orgasm and the time it takes for a woman to reach orgasm. Most women take several minutes to climax. Therefore premature ejaculation is a priority for couples to address early-on in order to have a mutually beneficial sexual relationship.
You may have discussed PE with your family members and found that several of you suffer from PE.
Does this then make your premature ejaculation psychological or physical?
That’s a tough question.
From an evolutionary standpoint, rapid ejaculation served to increase the chance for procreation and successful births. The man who could ejaculate fast could pass his genes more readily than one who could not. Fast ejaculation would also guard against being pushed out of the way by another man or be killed during reproduction. Thus, genes from fast ejaculators would be preserved, perpetuating the trait for generations.
Psychiatric or Trauma
There are two types of premature ejaculation; lifelong and acquired. Lifelong premature ejaculation is likely due to a deep-seated psychological problem, such as depression or anxiety. A deep anxiety about sex may be due to trauma during childhood or adolescence. Sexual assault, molestation, incest, and conflict with parents could lead to PE that starts early and persists. Lifelong PE starts with first attempt at coitus.
Acquired premature ejaculation occurs after a period of successful sexual encounters of normal duration. It is usually a type of performance anxiety; a fear of not pleasing their partner. Fear that premature ejaculation will occur can cause a self-fulfilling prophecy. A common ‘old’ excuse for this form of PE is to blame the partner for making the man extremely excited. Erectile dysfunction may precede the premature ejaculation in cases where exasperation is expressed by the partner or when a woman has a difficult time achieving orgasm by vaginal penetration. Women may conceal their frustration with feelings of inadequacy or lack the willingness to communicate their concerns.
Drugs and Alcohol
Psychotropic drugs may explain some cases of PE. Alcohol, however, should help PE unless the degree of intoxication to so high that erections cannot be obtained or sustained for vaginal penetration.
Lifelong premature ejaculation self-awareness test
In patients with lifelong premature ejaculation, some questions to ask yourself are:
What were my prior psychological difficulties?
What types of early sexual experiences did I have?
What were my family relationships during childhood and adolescence?
What were my peer relationships during childhood and adolescence?
What were my relationships like with the opposite sex during childhood and adolescence?
What is my overall attitude towards sex throughout my life?
What are my beliefs about sex out of wedlock?
What is my sexual attitude and partner response during sex
How do I feel about my partner in nonsexual aspects?
What are my cultural beliefs with regards to relationships and sex?
What are my religious beliefs with regards to relationships and sex?
Have I had any psychotropic drug use?
Do I experience erectile dysfunction?
Acquired premature ejaculation self-awareness test
In patients with acquired premature ejaculation, questions to ask yourself may be:
Is your premature ejaculation psychological, physical or both?
What was the quality of sex in previous relationships?
What is the quality of the sex in the current relationship?
What is the current nonsexual status of the relationship?
Do I have a history of erectile dysfunction?
Do I have a strong level of desire for sex?
Am I physically able to participate in sex?
What is the context of your sexual relations?
What is the sexual response of your partner?
Is my PE all in my brain?
Physical or psychological? Your recovery depends on this answer. Complete our FREE quiz to find out.
If your premature ejaculation is psychological you may be advised to undertake Behavioral therapy. This consists of guidance and reinstruction of appropriate masturbatory techniques:
The patient must be re‐taught techniques to include a softer grip of the penis with the hand and less forceful thrusting motions. If it is difficult to masturbate with bare hands, consider masturbating with cotton sheets, condoms, or gauze and gradually shift to bare hands. In some cases, training methods for masturbation can be accomplished in a simulated intravaginal environment provided by the TENGA® masturbatory aid. Adolescent sex education should include education on how to do proper masturbation to prevent PE.
Efforts to relief of underlying performance pressure on the male with relaxation techniques and other modalities
Sex therapy: the stop-start or squeeze-pause technique popularized by Masters and Johnson
Second attempt at intercourse:If another erection can be achieved shortly after an episode of premature ejaculation,then ejaculatory control may be longer the second time
Change Sexual Positions
A method of performing masturbation lying on the back and then inserting the penis into the vagina right before ejaculation with the partner in the astride position.
Medications may include the following:
Topical desensitizing (numbing) agents such as lidocaine and prilocaine for the male
Selective serotonin reuptake inhibitor (SSRI) therapy (eg, sertraline, paroxetine, fluoxetine, citalopram, or dapoxetine); alternatively, use of an agent with SSRI-like effect
Phosphodiesterase type 5 (PDE5) inhibitor therapy (eg, sildenafil, tadalafil, or vardenafil)
Other agents include pindolol or tramadol
Burgio, G.; Giammusso, B.; Calogero, A.E.; Mollaioli, D.; Condorelli, R.A.; Jannini, E.A.; La Vignera, S. Evaluation of the Mistakes in Self-Diagnosis of Sexual Dysfunctions in 11,000 Male Outpatients: A Real-Life Study in An Andrology Clinic. J. Clin. Med. 2019, 8, 1679. https://www.mdpi.com/2077-0383/8/10/1679/htm