Abstract
While anxiety is most often associated with male erectile disorder, it can also serve to distract a man's focus during lovemaking long enough to cause premature ejaculation (PE). A couple 21 years apart in age presented with severe PE (acquired, situational). The husband was a healthy, 60-year-old man who was afraid he could not “keep up,” sexually and otherwise, with his 39-year-old, highly energetic, sexually voracious wife. He feared she would leave him. The integration of PE exercises and psychodynamic couples therapy alleviated the PE and improved the overall relationship in 24 sessions. This success, however, was contingent upon both partners understanding and resolving their individual conflicts regarding power and control. These family-of-origin-based conflicts were found to be responsible for the couple's decision to mate, their general relationship strife, as well as the husband's anxiety and hence, his PE. Age difference played a vital role in that it served as the primary vehicle for the underlying conflicts.