Men who experience premature ejaculation frequently question their masculinity and lose confidence in their sexual performance, which often leads to feelings of lowered self-esteem. The term "premature ejaculator" itself implies that the man is somehow "underdeveloped" or "not fully mature". Therapists, when talking about this condition, generally prefer the term "rapid ejaculator", but this too, although less belittling, still has some implication that the man is defective or to blame. In fact, the issue of interest is not at all about the person but about the outcome, the earlier than desired ejaculation.

Early ejaculation, and a man's (or his partner's) associated negative feelings about the experience, can often lead to increasing preexisting communication issues in the relationship. In some cases, early ejaculation and the emotional feelings surrounding the experience, if not discussed openly and constructively, can lead to serious relational conflicts and more sexual problems, like erectile difficulties and decreased sexual desire by one or both partners.

Early ejaculation occurs in men of all ages and of all socioeconomic backgrounds. It has been reported in men who have no psychological problems as well as in those who are suffering from extreme stress and anxiety. A medical condition or physical reason is rarely found to be the cause of a man's problems with ejaculation. However, if someone has had a good history of ejaculatory control and then experiences early ejaculations, he should be seen by a competent urologist to determine if there is a treatable illness or neurological problem that has caused such a sudden change.

In most cases of early ejaculation the man has a history of concern and worry about his ability to control his ejaculation dating back many years, often to his first sexual relationship or before. Some therapists think that young men unknowingly are encouraged by events in their early sexual lives to teach themselves to ejaculate rapidly. Early experiences of masturbating quickly to get to the newfound good feeling of orgasm (or to avoid being caught), or rushing through sexual experiences in the back seat of a car, or on the family couch, may contribute to a young man unknowingly learning to ejaculate quickly.

It is important to know that it is neither uncommon nor abnormal for a man, on occasion, to experience early ejaculation. For example, if he has not had intercourse for some time, or is beginning to have sexual relations with a new partner, an episode of loss of control is not unusual. These instances of early ejaculation usually pass quickly and he returns, in a brief time, to his former level of control.

Psychological factors, such as fear of failure, or relationship issues, such as anger at one's partner, may have some bearing on a man's lack of ejaculatory control. There are several theories about the psychological causes for early ejaculation and each theory has its own therapeutic approach to helping the man improve his sense of control. Therapists treating a man, or a man and his partner, often address these issues during the course of treatment. However, the primary treatment of ejaculatory control is helping a man, by various techniques, to repeatedly focus his attention on the increasing erotic sensations in his body as he approaches orgasm. By increasing his awareness of the buildup of these pleasurable sensations he is better able to judge where he is along the path of reaching an orgasm and ejaculating. (Note: orgasm and ejaculation are separate events, caused by separate systems in the male's body, though they usually occur at the same time. The term orgasm is commonly used when speaking of a male's ejaculation. Technically, however, orgasm is just the peak of the intense pleasurable feeling that usually follows a man being highly sexually excited. Ejaculation is the term used for the expulsion of the fluids, the ejaculant, or cum, from the end of the penis.) He learns to make what has felt beyond his control more understandable and controllable. Focusing on the increasing erotic sensations of an impending orgasm, rather than trying to avoid feeling these sensations (by focusing on baseball scores, wearing two condoms, or applying desensitizing cream to the penis) has been proven the most successful method for assisting men and their partners in overcoming rapid ejaculation.