Even though premature ejaculation is the most widespread pathology of sexual behavior, it is still considered a psychological disease. Organic etiologies are only now becoming more evident. Premature ejaculation is largely under-diagnosed and under-treated, while erectile dysfunction has received great scientific and clinical attention in recent years. There are plenty of reasons for this: (i) PE is classically considered as psychogenic in nature; (ii) it is traditionally treated with behavioral psychotherapies; (iii) clear and accepted clinical definition(s) are lacking; (iv) the etiologies are largely unknown; (v) the pathogenesis is still obscure - there is a lack of awareness and acknowledgement of PE as a symptom of medical disease; (vi) lacking a medical presence in the field, requests for help from patients are low. Finally, erectile and ejaculatory dysfunctions frequently overlap. For all these reasons, an update on pathophysiology of premature ejaculation is to be considered the base for new pharmacological treatments. © 2006 European Association of Urology and European Board of Urology.