Premature ejaculation (PE) is a common sexual dysfunction affecting in a significant percentage of men across the globe. Most often, its psychological factors like stress or anxiety related to performance. But one recent case published in the Archives of Sexual Behavior, has revealed an uncommon physiological cause, challenging the established paradigm and underscoring the value of thorough medical workups.For years, a 32-year-old man struggled with premature ejaculation (PE), believing his performance anxiety to be the cause. Like many others with sexual dysfunction, he blamed his symptoms on stress and psychological issues. But when his symptoms intensified—along with unexplained symptoms such as pelvic pain and prolonged erections without stimulation—he knew there was something else going on.His search for answers or a certain reason resulted in an unexpected diagnosis- a vanishingly rare spinal cyst was compressing nerves that controlled sexual function, impairing his body's normal reaction. This epiphany not only altered his treatment but enlightened an under-recognized physiological mechanism of PE. When Anxiety Isn't the Cause of Premature Ejaculation?PE is among the most prevalent sexual disorders in men, occurring in as many as 30% globally. Although psychological issues—performance anxiety, stress, and depression—are often culprits, new research indicates that physiological explanations cannot be ruled out.Here, the patient's chronic symptoms, such as priapism (recurrent, throbbing erections) and pain on ejaculation, led physicians to consider other factors beyond anxiety. An MRI scan of his lower back uncovered an oval fluid sac called a Tarlov cyst compressing his sacral nerves—nerves responsible for sensation and function in the pelvic area.What Are Tarlov Cysts?Tarlov cysts, or perineural cysts, are cerebrospinal fluid-filled sacs that develop around nerve roots at the base of the spine. Most individuals with Tarlov cysts will never have any symptoms, but occasionally, when such cysts become large or compress nerves, they can create serious problems, such as:Lower back painSciatica-like symptomsBladder and bowel dysfunctionSexual dysfunction, including premature ejaculationThe sacral nerves have a very important function in passing signals between the brain and pelvic organs. Compression of these nerves results in the misfiring of the nerves, which leads to involuntary or exaggerated responses upon ejaculation.Once the underlying cause was determined, physicians advised surgery to excise the cyst and relieve pressure on the nerves. Post-surgery, the patient reported dramatic improvements—his premature ejaculation decreased, and he no longer suffered from priapism or pelvic pain. A check-up six months later confirmed the long-term efficacy of the treatment.This case highlights a valuable lesson: sexual dysfunction is not always psychological. Most men with PE might never think to look for an underlying neurological reason, resulting in misdiagnoses and useless treatments.For those with recurrent or worsening PE, particularly with other symptoms such as unexplained pain or irregular erectile function, a complete medical assessment—comprising imaging studies—can prove life-altering.