Savvy Psychologist

Understanding premature ejaculation: causes, symptoms, and treatment

Episode Summary

In this episode, we discuss premature ejaculation (PE). Dr. Johnson breaks down the DSM-5-TR definition, explores common causes and types, and offers mental health tips and treatment options for individuals navigating this experience.

Episode Notes

In this episode, we discuss premature ejaculation (PE). Dr. Johnson breaks down the DSM-5-TR definition, explores common causes and types, and offers mental health tips and treatment options for individuals navigating this experience.

Transcript for this episode

Savvy Psychologist is hosted by Dr. Monica Johnson. 

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Episode Transcription

Sex is everywhere, but real conversations about sexual concerns? Not so much. For many men, Premature Ejaculation (PE) isn’t just a source of private frustration—it’s a mental health issue that can affect self-esteem, relationships, and emotional well-being. Yet, it’s often misunderstood, dismissed, or cloaked in shame. That’s where I come in.

As a clinical psychologist, I’ve seen how silence around topics like PE does more harm than good. So, let’s break the stigma, unpack the official DSM-5-TR definition, explore the research, and wrap up with a few mental health tips to support those navigating this deeply human experience.

Welcome back to Savvy Psychologist, I'm your host, Dr. Monica Johnson. Every week on this show, I'll help you face life's challenges with evidence-based approaches, a sympathetic ear, and zero judgment.

What Is Premature Ejaculation?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), Premature (Early) Ejaculation is classified as a male sexual dysfunction. To receive a clinical diagnosis, the following criteria must be met:

1. Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately one minute following vaginal penetration and before the individual wishes it.
2. The symptoms must have been present for at least six months, and must occur on most (approximately 75% or more) occasions of sexual activity.
3. The condition causes clinically significant distress in the individual.
4. The sexual dysfunction is not better explained by a nonsexual mental disorder, relationship distress, substance/medication use, or another medical condition.

It’s worth noting:

• This definition is specific to vaginal intercourse, which is a limitation considering diverse sexual orientations and practices.
   
• The one-minute benchmark is a clinical guide, not an absolute—some cases may vary in context but still cause significant distress.

You may be wondering how common is premature ejaculation?

Research suggests PE is one of the most common male sexual complaints. Prevalence estimates vary depending on the population and definitions used, but here are the key numbers:

• Approximately 30% of men globally report experiencing PE at some point. 
• About 1–3% of men meet strict DSM criteria, suggesting most cases are subclinical yet still psychologically distressing.

Types of Premature Ejaculation

Psychologists and sexual health experts often break it down into two main categories:

1. Lifelong PE (Primary)
   
   
   • Present from the first sexual experiences
      
   • Often has a biological or neurochemical basis (e.g., serotonin regulation)
      
2. Acquired PE (Secondary)
   
   
   • Develops after a period of normal sexual function
      
   • More likely to be influenced by psychological, relational, or medical issues

Understanding which type you’re dealing with can help guide treatment strategies.

What Causes Premature Ejaculation?

There’s no single cause, but research points to a biopsychosocial model—meaning it’s often a mix of biological, psychological, and social factors.

Biological Factors

• Serotonin receptor sensitivity: Some men have lower serotonergic activity, which affects ejaculatory control.
   
• Prostatitis or thyroid dysfunction: Underlying medical conditions can increase sexual sensitivity.
   
• Genetics: Studies suggest a potential hereditary link to lifelong PE.
   

Psychological Contributors

• Performance anxiety: A major driver, especially in new or high-pressure sexual situations.
   
• Low self-esteem: Can lead to catastrophizing, hypervigilance, or avoidance.
   
• Conditioned response: If a man learned to climax quickly (e.g., due to fear of being caught during adolescence), that pattern may persist.
   

Relational and Social Factors

• Lack of emotional intimacy
   
• Communication difficulties in the relationship
   
• Cultural or religious shame around sex

PE can carry a deep emotional impact that ripples across many areas of life:

• Self-worth: Men often tie sexual performance to masculinity, leading to feelings of inadequacy.
• Relationship strain: Partners may feel unsatisfied or rejected, creating a cycle of blame and avoidance.
• Anxiety and depression: Studies show men with PE report higher rates of depressive symptoms, especially if they feel isolated or helpless.
• Sexual avoidance: Some men begin to avoid intimacy altogether to prevent shame or embarrassment.
   

Here is a broad overview of treatment options

1. General Therapy (especially CBT)

Cognitive Behavioral Therapy (CBT) helps clients identify distorted beliefs about sex, perfectionism, and performance. Techniques might include:

• Challenging shame-based thoughts
• Relaxation training and anxiety management

2. Sex Therapy

A trained sex therapist can guide couples through techniques such as:

• The "start-stop" or "squeeze" method which can help to slow down the process
   
• Communication coaching around sexual needs and feedback
   
• Exploring emotional closeness and pleasure beyond penetration.

3. Medical Treatment

• SSRIs (e.g., paroxetine or sertraline): These delay ejaculation by increasing serotonin levels.
   
• Topical anesthetics: Reduce penile sensitivity (e.g., lidocaine-prilocaine creams).
   
• Tramadol: An off-label opioid sometimes prescribed for PE (though with caution due to dependency risk).

4. Couples Therapy

Addressing emotional and sexual dynamics in the relationship helps reduce pressure and rebuild connection. 

I understand that therapy may take a minute, so here are a few general suggestions based on research. 

1. Talk to Your Partner (Even If It’s Awkward)

Silence feeds misunderstanding. Many partners are more supportive than we fear—especially when conversations are honest, not defensive. Try, “I’ve been feeling anxious about our intimacy and want us to talk through it together.”

2. Prioritize Pleasure Over Performance

Many men with PE focus so much on lasting longer that they lose sight of feeling close. Touch, eye contact, laughter, and intimacy are also forms of success. The tip here is to incorporate non-penetrative sexual experiences to take pressure off intercourse.

3. Limit the Comparison Game

Porn, media, and locker room talk set unrealistic expectations. Most people aren’t having porn-star sex. Trying to live up to fantasy-based norms only reinforces anxiety. Reduce porn use if it increases pressure or reinforces unhealthy sexual scripts.

4. Ditch the Shame Script

You are more than your performance. Shame thrives in silence. Whether you’re dealing with lifelong PE or a recent change, it doesn’t define your masculinity, your worth, or your capacity for intimacy. Practice reframing intrusive thoughts like “I’m not a man” into “I’m human and this is a common medical concern.” I get it, it can be embarrassing to have this as a chronic or occasional issue. But wagging your finger at yourself, isn’t going to make you or your downstairs neighbor stand up any taller. 

Premature ejaculation is not a punchline. It’s not a weakness. It’s not the end of a fulfilling sex life. It’s a treatable concern that many men face—and that most couples can navigate with compassion and skill-building.

For my take on other sexual health topics, such as understanding desire discrepancies, erectile dysfunction, the fundamentals of great sex and more, check out the playlist in the show notes. 

Do you have any sex or relationships questions you’d like me to explore? Let me know! You can contact me via Instagram @kindmindpsych or via my email at psychologist@quickanddirtytips.com.

The Savvy Psychologist is a Quick and Dirty Tips podcast. It's audio engineered by Steve Riekeberg. The Director of Podcasts is Holly Hutchings. Our Podcast and Advertising Operations Specialist is Morgan Christiansen, and Nathaniel Hoopes is our Marketing contractor. Follow Savvy Psychologist on Apple Podcasts, Spotify, or wherever you listen to podcasts. That's all for this episode of Savvy Psychologist. Thanks for listening! I'll see you next week.