The cause of premature ejaculation

Causes
The cause of premature ejaculation is considered psychological, although no one really knows.
Primary premature ejaculation
In primary premature ejaculation, in which the male has never experienced sexual relations without also experiencing premature ejaculation, a deep-seated emotional disturbance (see History) may be present and the causes may be multiple.
Sometimes, the behavior is a conditioned response resulting from teen masturbation practices (see Introduction), but, sometimes, the patient has deep anxiety about sex that relates to one or more traumatic experiences encountered during development. Examples may include family incest, sexual assault, conflict with one or both parents, or other serious disturbances.
In most cases, a primary care physician or a urologist should consult with a psychiatrist, psychologist, or other professional in cases of primary premature ejaculation.
Secondary premature ejaculation
With regard to secondary premature ejaculation, some type of performance anxiety is often a major factor.
Performance pressure (ie, fear of failure to satisfy the partner) can arise from various precipitating events. ED is a common precipitating event. If the male is afraid his erection will not last, because of either actual instances of previous ED or imagined failure of his erection, this may precipitate premature ejaculation. The patient may have used the phrase, "Honey, you excited me so much I just could not hold back," which might be a way for him to avoid admitting to the humiliation of being unable to keep his erection throughout intercourse. If he climaxes quickly, he then has an excuse to justify his inability to maintain his erection.
However, a careful history (see History) is needed because the situation may be complex.
Perhaps ED is not a part of the problem.
Possibly, his partner has belittled him with comments such as "You must not be much of a man, since you cannot stay hard until I am satisfied." In addition, she actually may have difficulty achieving climax through intercourse and may require direct clitoral stimulation to reach a climax. If she does not communicate this to him (and she may conceal it because of feelings about her own inadequacy), then he will always fail to provide coital satisfaction for her.
Because most physicians are not trained sex therapists, sorting out conflicts in the relationship and then referring couples for counseling to professionals with experience and training in that area is important. If a physician has some training or experience in the treatment of premature ejaculation and is comfortable managing the problem, then the physician may choose to begin treatment (eg, counseling, medication, both). If the patient does not respond favorably or if the physician is not comfortable with the treatment of premature ejaculation, then referral to a sex therapist, psychologist, or psychiatrist is the next step.