The initial management of premature ejaculation (PE) involves a thorough history-taking to differentiate between primary and secondary PE and assess contributing factors. Psychological, relationship, and medical aspects are explored, along with potential trauma or past experiences. Differential diagnoses, including anorgasmia and adverse effects of medication, are considered. Physical examination typically reveals no abnormalities, although underlying conditions such as chronic preputial infection or inflammation may be present. The causes of PE are primarily psychological, although neurological factors may play a role. Treatment options include pharmacotherapy, behavioral therapy, and topical therapies. Selective serotonin reuptake inhibitors (SSRIs) are the mainstay of medical treatment, while behavioral therapy techniques such as the stop-start method and the squeeze technique are effective in addressing performance anxiety. Topical anesthetics and PDE-5 inhibitors may also be used. Surgical interventions are not recommended. Consultation with a sex therapist or mental health professional may be beneficial, and patient education is essential for successful management. Despite high success rates with treatment, relapse rates are significant, emphasizing the importance of long-term commitment to therapy. Overall, a comprehensive approach combining medical and behavioral interventions offers the best chance for improving outcomes in patients with PE.