Premature ejaculation (PE) has long been viewed as primarily psychogenic, but evolving understanding of male sexual physiology suggests an organic basis. While historically linked with anxiety, PE is now recognized to involve factors such as penile hypersensitivity and serotonin receptor dysfunction. The definition of PE varies, encompassing ejaculation with minimal stimulation, often preceding or occurring shortly after penetration, leading to distress and lacking voluntary control. Primary PE occurs from initial sexual experiences, while secondary PE arises later, often associated with psychological factors and relationship dynamics. Understanding a patient’s sexual history, familial relationships, peer interactions, and psychological attitudes is crucial in diagnosis and treatment planning. Secondary PE may stem from relationship issues or concomitant erectile dysfunction (ED). Comprehensive assessment, including evaluation of relationship quality and sexual response, informs tailored interventions. Treatment of ED alongside PE may be necessary if both conditions coexist, emphasizing the importance of addressing underlying causes. Classification of PE based on onset and contributing factors guides therapeutic approaches, with secondary PE generally exhibiting a more favorable prognosis. By integrating psychological, relational, and physiological considerations, clinicians can effectively manage PE, improving patient outcomes and sexual well-being.