Let's talk about the causes of premature ejaculation.

Let's first talk about the manifestations of premature ejaculation. Men with premature ejaculation typically exhibit these eight symptoms:
1. Ejaculating after only a brief rub at the vaginal opening during penetration;
2. Ejaculating within seconds/minutes during masturbation or after penetration;
3. Taking a long time to masturbate, ejaculating quickly while watching porn, and even faster during actual intercourse;
4. Ejaculating while touching or pressing the penis during porn;
5. Ejaculating before achieving an erection due to psychological tension and excitement
; 6. Ejaculating quickly the first time after a long separation, but taking longer the second time;
7. Ejaculating quickly once, and then quickly every time afterward;
8. Normal performance with the spouse, but quick performance during infidelity.
These eight types of premature ejaculation share some similarities but also have different causes.
In general, premature ejaculation is the result of multiple factors.
Based on the timing of its onset, premature ejaculation can be divided into primary premature ejaculation and secondary premature ejaculation. Primary premature ejaculation refers to premature ejaculation that has been present since the first sexual intercourse; secondary premature ejaculation refers to premature ejaculation that occurred later due to certain reasons after previously having normal sexual intercourse duration. Causes of premature ejaculation include: psychological barriers, penile hypersensitivity, habitual premature ejaculation due to long-term improper masturbation, PC muscle dysfunction, physical function, prostatitis, and improper sexual technique. All of these factors can lead to premature ejaculation.
1. Psychological Barriers Leading to Premature Ejaculation: Regarding psychological causes, a survey analysis published in the *Chinese Journal of Urology* by Liu Jishuang et al. from the First Affiliated Hospital of Anhui Medical University showed that: "Among 1164 patients with premature ejaculation, 558 had symptoms of anxiety and depression. Psychological barriers are common among patients with premature ejaculation and are related to multiple factors; psychological barriers are closely related to premature ejaculation." (Reference: Liu Jishuang, Zhang Xiansheng, Xia Lei et al. "Investigation and Analysis of Psychological Barriers in 1164 Patients with Premature Ejaculation". *Chinese Journal of Urology*, 2012, Vol. 4.) Psychological barriers, such as tension, excitement, and anxiety during sex, activate the sympathetic nervous system. At this time, the whole body tenses up, and the level of excitement rises rapidly. The body will try to end this negative state as quickly as possible through rapid ejaculation, i.e., premature ejaculation.
Four common manifestations of premature ejaculation caused by psychological factors: > Psychological tension and anxiety, ejaculating before the penis is even erect; > Ejaculating very quickly during one instance, and then every time; > Long duration of masturbation, but quick ejaculation during intercourse; > Normal ejaculation with the spouse, but quick ejaculation during infidelity. Don't worry too much about these reasons.
We can eliminate the influence of psychological factors on premature ejaculation through psychological training and modified sensate focus training.
2. Hypersensitivity of the penis leading to premature ejaculation: An analysis article published in *Chinese Journal of Sexology* by Zhang Junqiang et al. from Peking Union Medical College Hospital and Baotou Central Hospital, regarding excessive penile sensitivity, stated: "Premature ejaculation is caused by the dysfunction of the ejaculation center's ability to distinguish penile sensations due to hypersensitivity of the penis or increased excitability of sensory nerves." (Reference: Zhang Junqiang, Liu He, Li Hanzhong. "Advances in the Diagnosis and Treatment of Premature Ejaculation." *Chinese Journal of Sexology*, 2006, Vol. 1.) Therefore, because the penis is overly sensitive, the excitability of sensory nerves is increased, but the ejaculation center lacks the regulation and control of the excitability level, leading to premature ejaculation.
Three common manifestations of premature ejaculation due to high sensitivity are: > Ejaculation occurs after only a brief rub at the vaginal opening during penetration; > Ejaculation occurs within seconds/minutes during masturbation or after penetration; > Excessive arousal during the first sexual encounter, with no reduction in arousal level leading to premature ejaculation. We also learn to regulate and reduce arousal levels through training, specifically reducing psychological and physiological sensitivity.
3. Long-term incorrect masturbation can lead to premature ejaculation. Many men may have this problem.
Scientific evidence shows that moderate and correct masturbation is harmless; however, long-term incorrect masturbation is harmful and can easily lead to habitual premature ejaculation. Habitual premature ejaculation was first discovered by American sex physiologists Masters and Johnson. Their research is included in the *Encyclopedia of Human Sexuality*: "Adolescents learn to ejaculate quickly and habitually during masturbation because they are afraid of being discovered by their parents." (Reference: *Encyclopedia of Human Sexuality*, Garland Publishing Inc., author: Vern L. Bullough) Meanwhile, *Practical Diagnosis and Treatment of Male Sexual Disorders* (authors: Jiang Yu, Yao Dehong), published by Fujian Science Press, also points out: "Masturbators often force themselves to ejaculate quickly, which becomes a habit over time, causing anxiety and fear about premature ejaculation."
Because of fear of being discovered, or in pursuit of stimulation, masturbation often involves rapid hand movements to achieve faster ejaculation, leading to increasingly faster speeds.
Over time, the ejaculation center gradually develops a rapid conditioned reflex to sexual stimulation; that is, the ejaculation center habitually issues the ejaculation command as soon as the body comes into contact with sexual stimulation, resulting in ejaculation… even if the penis is still flaccid.
Four signs of premature ejaculation caused by long-term incorrect masturbation: > Ejaculating after only rubbing the vaginal opening during penetration; > Ejaculating after touching or pressing the penis while watching porn; > Ejaculating within seconds of masturbation or penetration; > Ejaculating while the penis is still flaccid during masturbation or foreplay. Habitual premature ejaculation developed through long-term masturbation naturally leads to "quick shooters" in actual intercourse.
Of course, masturbation and intercourse are very different: masturbation relies solely on tactile stimulation from hand movements, while intercourse involves not only tactile stimulation from the vagina but also visual, auditory, and olfactory stimulation. The combined stimulation of actual sex is greater, so some people can masturbate for a long time while masturbating, but still ejaculate quickly in actual sex. Moreover, even if you quit masturbating, this habitual premature ejaculation won't change.
For this situation, the first thing to do is to learn self-control and reduce the frequency.
Afterwards, behavioral training methods can be used to correct habitual premature ejaculation caused by long-term incorrect masturbation. 4. The Influence of PC Muscle Function on Premature Ejaculation The PC muscle, also called the pelvic floor muscle, is a group of muscles in the human genital area. A study published in *Chinese Journal of Sex Science* by Professor Tian Juqun of the National University of Defense Technology analyzed and demonstrated the function and influence of the pelvic floor muscle (PC muscle) and pointed out that "scientific training can improve pelvic floor muscle function, thereby enhancing an individual's sexual ability." However, those who sit for long periods often have relaxed pelvic floor muscles (PC muscles), which easily leads to sexual dysfunction. (Reference: Tian Juqun. "Sexual Behavior, Pelvic Floor Muscles and Chronic Pelvic Pain". *Chinese Journal of Sex Science*, 2013, No. 1.) Here, sexual ability includes erectile function and duration.
This proves that prolonged sitting can relax the PC muscles, which manifests during sex as: lack of control over ejaculation, weak ejaculation, and low ejaculatory pleasure. Therefore, we need to train the PC muscles to prolong the duration and make ejaculation more pleasurable and powerful.
5. The impact of physical function on premature ejaculation: Most men with premature ejaculation lack exercise and generally have weak physical function. A research article published in the *Chinese Journal of Tissue Engineering Research* by Professor Li Aihua et al. of the Department of Urology, Yangpu District Central Hospital, Shanghai, showed that: "After 14 weeks of aerobic exercise, elderly men participating in the study had a biological age lower than their actual age, enhanced cardiopulmonary function, and significantly improved various physical function indicators. Aerobic exercise can delay male aging." (Reference: Li Aihua, Chen Peijie. "The effect of 14 weeks of incremental load aerobic exercise on the biological age of elderly men at different stages of aging." *Chinese Journal of Tissue Engineering Research*, 2007, No. 39.) Elderly men have relatively weak physical function and sexual ability, but after 14 weeks of aerobic exercise, they became younger, and both physical function and sexual ability were enhanced. This also illustrates that a lack of aerobic exercise can weaken bodily functions. Weak bodily functions typically manifest during sex as: premature ejaculation, weak ejaculation, and post-ejaculation fatigue. Therefore, we should enhance bodily functions through aerobic exercise.
6. The Impact of Prostatitis on Premature Ejaculation: Regarding the impact of prostatitis on premature ejaculation, an analysis article published in the *Chinese Journal of Andrology* by Chen Xiang et al. from Renji Hospital affiliated with Shanghai Jiao Tong University School of Medicine showed that: "Among 1988 patients with premature ejaculation, the incidence of secondary premature ejaculation due to chronic prostatitis was 60.75%, far higher than other types of premature ejaculation. All of the above studies indicate that chronic prostatitis is related to the occurrence of premature ejaculation, and is most closely related to secondary premature ejaculation." (Reference: Chen Xiang, Dai Jican. Research Progress on Organic Etiology of Premature Ejaculation. *Chinese Journal of Andrology*, 2014, No. 8.) Symptoms of prostatitis: lower abdominal pain, perineal distending pain; painful urination, frequent urination, incomplete urination; milky white discharge from the urethra upon waking, and milky white discharge from the urethra after urination or defecation. Whether it is prostatitis should be determined by examination at a regular public hospital.
7. Premature ejaculation caused by improper operation: Some men, during intercourse, do not pay attention to rhythm and technique, thrusting forcefully and rapidly from the start. The penis cannot adapt to such excessive stimulation in a short time, causing a rapid spike in arousal level, leading to premature ejaculation after only a short period of thrusting. This is premature ejaculation caused by improper operation. The correct approach is to gradually increase the stimulation, from shallow to deep, from slow to fast, and from light to heavy, allowing the penis to slowly adapt to the vaginal environment and thus prolonging the duration.
Summary of causes of premature ejaculation: Premature ejaculation is usually the result of multiple factors: Primary premature ejaculation often results from an overly sensitive penis lacking regulation and control over arousal; secondary premature ejaculation may initially appear normal, but long-term incorrect masturbation gradually leads to habitual premature ejaculation; prolonged sitting due to study or work can cause PC muscle relaxation; and age-related lack of exercise can lead to a decline in physical function… When these factors accumulate to a certain point, premature ejaculation finally occurs during a sexual encounter, causing the man to become very anxious, worrying about future premature ejaculation. The more one worries and becomes anxious, the more this psychological barrier exacerbates premature ejaculation. If one also suffers from urinary system diseases such as prostatitis, premature ejaculation is even more likely. Some people wonder if phimosis (tight foreskin) can also cause premature ejaculation. In response, a meta-analysis published in the *Chinese Journal of Andrology* by Fan Ning et al. from the Second Hospital of Lanzhou University, after analyzing 15,280 patients who underwent circumcision and 17,189 control subjects, concluded that: "Circumcision has no significant impact on patients' libido, erectile function, ejaculation/ejaculation time, orgasm, and sexual satisfaction; there is insufficient evidence to suggest that circumcision is effective in treating premature ejaculation." (Reference: Fan Ning, Zhang Lixiu, Zhang Xudong. Meta-analysis of the effects of circumcision on sexual function. *Chinese Journal of Andrology*, 2017, No. 6.) After circumcision, the foreskin in men with phimosis returned to normal, but the ejaculation/ejaculation time did not change significantly, proving that phimosis is unrelated to premature ejaculation.

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