Fact check: What are the most common causes of premature ejaculation in men?

1. Summary of the results

Based on the comprehensive analyses provided, premature ejaculation affects 20-30% of sexually active men and has multiple interconnected causes that can be broadly categorized into biological, psychological, and medical factors ^[1].

Biological and Neurological Causes:

• Abnormal neurotransmitter levels, particularly low serotonin, are a primary factor ^{[2] [3] [4]}
• Disruptions in neurotransmitter activities involving serotonin, noradrenaline, and oxytocin ^[4]
• Serotonin receptor dysfunction and genetic polymorphisms ^{[5] [6]}
• Increased penile sensitivity or penile hypersensitivity ^{[4] [5]}
• Hormonal imbalances and genetic predisposition ^{[2] [5]}

Medical Conditions:

• Hyperthyroidism is consistently mentioned across multiple sources ^{[1] [7] [3]}
• Diabetes and hypertension ^{[2] [3] [5]}
• Erectile dysfunction and chronic prostatitis ^{[7] [1] [4]}
• Prostatic diseases and endocrine disorders ^[4]

Psychological Factors:

• Performance anxiety and sexual performance anxiety ^{[1] [7] [3] [5]}
• Depression, stress, and anxiety disorders ^{[3] [8]}
• Relationship problems and interpersonal factors ^{[1] [7]}
• Poor sleep quality is closely correlated with premature ejaculation ^[8]

2. Missing context/alternative viewpoints

The analyses reveal important distinctions that provide crucial context:

Classification Types: Premature ejaculation can be classified into four distinct types: primary, secondary, natural variable, and subjective PE ^[1]. The causes vary significantly between lifelong PE (which has more genetic and neurobiological factors) and acquired PE (which is more closely linked to medical, psychological, and interpersonal factors) ^{[1] [4]}.

Age and Demographics: Acquired PE is more likely to occur in older men with higher BMI and more comorbid conditions compared to lifelong PE ^[7]. This demographic information is crucial for understanding risk factors.

Prevalence Variability: The prevalence ranges dramatically from 20-75% depending on definition and study methodology ^[6], indicating significant variability in how the condition is measured and reported.

Substance-Related Factors: Drug withdrawal and substance abuse are identified as contributing factors ^{[7] [3] [1]}, which may be underreported or stigmatized causes.

3. Potential misinformation/bias in the original statement

The original question itself does not contain misinformation, as it simply asks for factual information about causes. However, there are potential areas where incomplete information could lead to misunderstanding:

Oversimplification Risk: Simply listing "common causes" without acknowledging the complex interplay between psychological, biological, and medical factors could lead to oversimplified treatment approaches ^{[4] [6]}.

Missing Complexity: The question doesn't acknowledge that the etiology varies significantly between different types of PE (lifelong vs. acquired), which could lead to inappropriate treatment strategies ^{[1] [4]}.

Psychological Stigma: There may be underreporting of psychological causes due to stigma, as one source specifically mentions "barriers to recognition and treatment" related to the psychological impact ^[5].

Cultural Bias: One study focuses specifically on Chinese outpatients ^[8], suggesting that cultural factors and population-specific research may influence our