What is the pathophysiology of premature ejaculation (PE)?

Updated: Jan 15, 2019
  • Author: Samuel G Deem, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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Some have questioned whether premature ejaculation is purely psychological. A number of investigators have found differences in nerve conduction/latency times and hormonal differences in men who experience premature ejaculation compared with individuals who do not. The theory is that some men have hyperexcitability or oversensitivity of their genitalia, which prevents downregulation of their sympathetic pathways and delay of orgasm.

Electroencephalography and neuroimaging studies have detected abnormal spontaneous and evoked brain activation responses to erotic stimuli as well as brain structure changes in premature ejaculation patients. A study by Yang et al using functional magnetic resonance imaging (fMRI) demonstrated that patients with lifelong premature ejaculation have an abnormal brain control network, which may contribute to the reduced central control of rapid ejaculation. [6]

A group of nerves in the lumbar spinal cord has been identified as the possible generator of ejaculation. This nerve site is thought to be linked to excitatory and inhibitory dopamine pathways in the brain, which play significant roles in sexual behavior. While research continues, this knowledge is providing the foundation for possible development of medications specifically targeting delay of ejaculation. [7, 8]

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