The causes for primary premature ejaculation can be a deep-seated emotional disturbance, a behavior (conditioned response) that results from teen masturbation practices, family incest, sexual assault or a serious disturbance within the family. A doctor or urologist will usually ask for a consult with a psychiatrist or psychologist for assistance with treatment.

Secondary premature ejaculation is usually performance anxiety related. Performance pressure can come from fear of not being able to satisfy the partner, being overly worried about events not related to sex, can stem from previous erectile dysfunction. A partner who belittles the male or has difficulty achieving a climax and blames him can also lead to feelings of inadequacy that can lead to penile dysfunction.

Counseling individually or as a couple with trained sex therapist is usually a part of the treatment plan.

The doctor will want to rule out other causes for the premature ejaculation such as anorgasmia or severely delayed orgasm in the female partner. The sexual response of the partner is almost always to be considered in cases of premature ejaculation.

It should be ruled out that the man isn't just confusing premature ejaculation with what is referred to as "pre-come" which is lubricating fluids that are expressed from glands during the excitement phase of sexual excitement.

Erectile dysfunction is a clinical symptom for some men who are experiencing premature ejaculation, so it is important for the doctor to be able to medically separate the occurrence of these two penile difficulties and to determine if they are both present, which one occurred first.

After the questionnaire and physical exam are finished the doctor may as part of the diagnosis ask the male to undergo some laboratory testing which may include checking the serum testosterone level and the prolactin level (blood test)

Tests to determine the presence of depression will also be conducted.

Vibrational threshold testing may be done voluntarily as well as nerve conduction times may be tested.

Treatment may be a combination of psychological therapy, couples sex therapy, medications which may include both oral and topical, and several methods may be taught that will help to teach the male how to control ejaculation (stop-start and the squeeze-pause).

Treatment almost always includes a combination of therapy (individual or couples) which will address any anxiety or depression issues, or issues with unresolved sexual misconduct perpetrated on the male during his youth. Issues of behavior modification stemming from habits fostered while a teen such as getting into the habit of speeding up ejaculation due to being pressured so as not to get caught need to be corrected and new habits formed regarding timing.

Couples sex therapy will teach both how to relax more and how to arouse the entire body so that sex can be more pleasurable and will take the pressure off of the penile area.

Medications will be prescribed to help with anxiety or depression as well as a tool for over sensitized penis (topical anesthetic). If the male is too stressed out or uptight, medications may be prescribed to relax him.