Premature ejaculation/rapid ejaculation is a common but incompletely understood male sexual dysfunction. The purposes of this review are to 1) raise awareness of the prevalence and characteristics of PE/RE, its impact on the male and his partner, and the lack of approved medications indicated for its treatment, 2) encourage dialogue about PE/RE between physicians and patients, and 3) stimulate the development of appropriate new therapies. A MEDLINE search was performed to retrieve articles relating to PE/RE pathophysiology, etiology, impact, diagnosis and treatment. Sexual medicine journals not indexed in MEDLINE, sexual medicine texts and congress abstracts were also reviewed. No universally accepted definition, licensed treatment, validated screening instrument or diagnostic criteria have been established for PE/RE, and its pathophysiology and etiology are incompletely understood. Additional barriers are the reluctance of patients and physicians to talk about PE/RE and the lack of knowledge regarding available treatments. Current pharmacological treatments include off label uses of antidepressants, topical anesthetics or phosphodiesterase-5 inhibitors. All are associated with drawbacks that limit their efficacy. Psychological counseling and behavioral therapy have a valuable role, although resources for this modality are limited. Prevalence rates of 20% to 30% and negative effects on the quality of life of men and their partners illustrate the need for improved, standardized methods of PE/RE diagnosis, assessment and treatment. Medications indicated specifically for PE/RE and effective on an as needed basis are required. Behavioral therapies should emphasize pleasure, arousal, control, confidence and satisfaction, and they may have the best success when coupled with pharmacological approaches.