Premature Ejaculation (PE) and Delayed Ejaculation (DE) are two common sexual concerns that can have a profound impact on individuals and relationships. These are real and treatable conditions. Seeking help is a courageous step towards addressing them. 

At New Moon Psychotherapy, our therapists have specialized training that allows them to understand and supporting individuals experiencing ejaculation difficulties, including premature and delayed ejaculation. This includes understanding that not only cis-gender males experience premature or delayed ejaculation. Our therapists have specialized knowledge and welcome trans, intersex and non-binary individuals.

We are here to provide information, support, and hope as we discuss these concerns, their potential causes, and how psychotherapy can be a valuable tool in their treatment. 

What are the Causes of Premature and Delayed Ejaculation?

There are a number of psychological, biological and physiological, and relational factors that contribute to premature ejaculation and delayed ejaculation. These difficulties can also be a symptom of serious health conditions. For this reason, it is important that you are assessed by a medical doctor if you begin to experience premature or delayed ejaculation. Medical assessment typically involves a physical exam, blood work, and visit with a specialist (urologist). This is the first step to determining which intervention would be most suitable for you.

Psychological Factors 

The psychological causes of premature ejaculation and delayed ejaculation are often interrelated, with several factors contributing simultaneously and reinforcing the impact. Psychotherapy and sex therapy specifically can help individuals and couples explore their emotions, thoughts, and relationship dynamics to overcome premature and delayed ejaculation and improve overall sexual well-being.  

Below are some common psychological factors impacting ejaculation. 

Stress and Anxiety

High levels of anxiety or stress can interfere with sexual arousal and response. Recurring, intrusive thoughts or preoccupation with work stressors, financial concerns, or other distractions can hinder arousal and prevent ejaculation. Unresolved childhood traumas, or internalized emotional conflicts from one’s family of origin can also contribute. 

Sexual Performance Anxiety

Anxiety about sexual performance and the fear of ejaculating too quickly can create a self-fulfilling prophecy and result in premature ejaculation.

Research shows that many men who experienced premature ejaculation described themselves as feeling nervous, acting hastily, and ejaculating prematurely during their first sexual experience.

Worrying about one’s sexual performance, particularly in a new relationship or when there is pressure to perform, can result in delayed ejaculation. The fear of not living up to own or a partner’s expectations can be paralyzing. 

Sexual Trauma

Past experiences of sexual trauma or abuse can lead to psychological triggers that cause rapid ejaculation. Likewise, these experiences can result in a dissociative state in which one feels disconnected from the sexual experience, causing delayed ejaculation.

Trauma can create emotional triggers that bring up intrusive thoughts, emotions, and physical sensations that interfere with sexual functioning and ejaculation  

Negative Beliefs About Sex

Negative beliefs or attitudes about sex and sexuality can lead to performance anxiety, which can manifest as premature ejaculation. These beliefs can be rooted in cultural, religious, or personal upbringing which result in inhibition and emotional barriers to sexual enjoyment. 

Depression

Depression can decrease sexual desire and cause emotional numbness which makes it difficult to achieve orgasm. This coupled with an overall decrease in interest in sexual activities can contribute to erectile difficulties. 

Body Image and Self-Esteem

Negative body image or low self-esteem can leave us feeling insecure and unattractive and reduce our feelings of confidence regarding our performance. This can create mental obstacles to ejaculation and satisfying sexual functioning. 

Pressure to Delay Ejaculation

In some cases, the person with a penis may intentionally try to delay ejaculation in order to offer greater sexual satisfaction for their partner. This pressure can result in delayed ejaculation, or paradoxically, premature ejaculation.

Biological and Physiological Factors

There are various biological/physiological factors which may contribute to premature or delayed ejaculation. These can include:

Sensitivity

Some men may experience reduced genital sensitivity, which can result in difficulty reaching ejaculation. This can be age-related or related to other physiological factors.

Hypersensitive Ejaculatory Reflex is a condition during which a man’s pelvic muscles contract too quickly. This can result in rapid ejaculation.

Neurotransmitters

Imbalances in neurotransmitters, such as serotonin and dopamine, can affect ejaculatory control. Low serotonin levels, in particular, are associated with premature ejaculation.

Hormonal Imbalances

Hormones play a significant role in the physiological aspects of ejaculation. For example, low testosterone levels, can affect sexual function, including the ability to ejaculate.

High testosterone levels correlate with premature ejaculation, while low levels of testosterone correlate with delayed ejaculation.

Neurological Factors

In some cases, delayed ejaculation may be related to neurological conditions or damage. For example, conditions such as Parkinson’s, traumatic brain injury, multiple sclerosis or spinal cord injuries can interfere with the signals between the brain and the genitals, resulting in ejaculation difficulties.

Prostate Issues

Issues with the prostate, such as infection or inflammation, can interfere with physiological processes involved in ejaculation.

Medications

Certain medications may cause delayed ejaculation as a side effect. Particularly, medications that affect the central nervous system because they alter the normal physiological response to sexual stimulation. Examples include – anticholinergics, antihypertensive, SSRIs, and antipsychotic medication.

Other physiological factors

Radical prostatectomy (removal of prostate gland to treat prostate cancer, pelvic trauma or surgery, Urological problems, cardiovascular disease, and withdrawal from opiates and alcohol can also contribute to premature ejaculation.

Relationship Issues

Problems in a relationship, including communication difficulties, emotional distance, lack of intimacy, recurring conflict, relationship dissatisfaction, power and control struggles, can impact sexual performance and result in premature or delayed ejaculation.

Overreliance on a partner’s arousal, insufficient stimulation, power dynamics, over concern about pleasing partner, specific and rigid masturbation practices, and inability to replicate masturbatory fantasies in real like are associated with delayed ejaculation.

Premature and delayed ejaculation are often experienced as co-occurring with other sexual difficulties such as erectile dysfunction.

How Can Therapy Help? 

Psychotherapy, or talk therapy, can be a valuable component of treatment for premature or delayed ejaculation. Psychotherapy that focuses on premature or delayed ejaculation is referred to as sex therapy. Here are some ways that sex therapy can help: 

Identifying Underlying Factors 

A trained therapist can help you explore the emotional and psychological factors contributing to premature or delayed ejaculation. This process can provide valuable insights into the causes of your condition.

Coping Strategies

Therapy equips you with effective coping strategies to manage anxiety, performance pressure, and relationship issues. You’ll learn relaxation techniques and ways to reframe negative thoughts.

Sensate Focus Exercises

These exercises, guided by a therapist, help improve sexual awareness and enhance intimacy between partners, which can be beneficial for both premature and delayed ejaculation. The activities can be performed alone or with a partner. Therapy will involve processing the exercise and any physical, emotional, or cognitive (thoughts) difficulties that came up during the process.

Communication Skills

Strong communication is the foundation of a satisfying and fulfilling sex life. It can reduce anxiety and enhance sexual satisfaction. Sex therapy often involves teaching communication skills and addressing difficulties within a relationship. For this reason, it can be beneficial to involve a partner (if available) in the therapy process eg. Couple’s therapy.

Medical Integration

Sex therapy is not a replacement for medical and pharmacological intervention. However, research consistently shows that treatment outcomes are enhanced when combined with sex therapy.