Etiology of Premature Ejaculation: Neurobiological,

Neurobiological and Physiological Determinants

The etiology of premature ejaculation involves a complex interaction of organic and neurobiological mechanisms.

At the neurochemical level, alterations in central receptors for neurotransmitters such as serotonin play a decisive role in regulating the ejaculatory reflex threshold.

Likewise, relevant peripheral factors are observed, notably somatosensory hypersensitivity in the glans and increased neuronal representation via the pudendal nerve.

Added to these components are various underlying medical conditions, such as chronic prostatitis, varicocele, thyroid dysfunction, or alterations in oxytocin levels.

Although it was historically considered a purely psychogenic disorder, clinical evidence confirms that genetic and neurobiological variations predispose men to shortened ejaculatory latency, which is subsequently modulated by the environment.

Psychological Factors and Performance Anxiety

On the psychological front, performance anxiety is one of the main drivers that triggers and sustains a lack of ejaculatory control.

Constant concern about pleasing one’s partner, anticipatory fear of failure, and the “spectator role”—in which the individual obsessively monitors his own erotic response—activate the sympathetic nervous system, accelerating the ejaculatory process.

Furthermore, the presence of unresolved conflicts in the couple’s dynamic, a lack of intimate communication, depressive states, and unrealistic expectations regarding sexual performance increase emotional tension.

This emotional overload hinders the conscious perception of the proprioceptive sensations that precede the point of inevitable ejaculation, preventing self-regulation.

Learning, Masturbation Habits, and Conditioning

Behavioral conditioning and early learning play a crucial role in the establishment of premature ejaculation.

Patterns of adolescent self-stimulation characterized by haste, the urgency to relieve tension, or the fear of being discovered train the nervous system to reach climax hastily.

Likewise, compulsive masturbation associated with pornography consumption reinforces an erotic response geared exclusively toward rapid release, without plateau or relaxation phases.

This lack of training in distinguishing between levels of arousal prevents men from developing tolerance to intense stimulation.