Premature ejaculation is probably the most common sexual "dysfunction" for men, with incidence rates somewhere between 10-40%, depending on how it is defined. About 5-10% of men regularly ejaculate within a few minutes of penetration.

Although PE is not as disruptive as impotence, regular rapid ejaculation causes a great deal of discomfort and frustration for both partners. So it is surprising how much misinformation is published on the subject.

Clinical approaches up till the early 1990s revolved around psychological treatments which were rarely effective beyond the treatment period. But after noticing that some prescription medications (especially anti-depressants) caused delays in ejaculation, researchers began looking for a physiological mechanism and they have now verified that there is such a mechanism.

They found that men with lifelong rapid ejaculation have dominant sympathetic activity, leading to quick arousal. (Sympathetic and parasympathetic functions are the two balancing forces in the nervous system – excitatory and inhibitory). Men with lifelong premature ejaculation also have specific imbalances in neurotransmitter function, and increased sensitivity to vibration in the pelvic area.

Modern clinical treatment has moved from a psychological to a biochemical approach using medication. Unfortunately, till recently, drugs used to manage rapid ejaculation needed to be taken over a period of time and caused other negative sexual side effects.

The newly available medication dapoxetine (approved in some countries but not yet the US) is a short-acting version of older treatments, and reduces many of these problems. It typically delays ejaculation by about 300% if taken one hour before sex.

While effective, dapoxetine is expensive, may cause nausea and there is little research on the long term health effects of using it regularly. Other pharmacological treatments are being investigated.

And although they are not widely publicized, there are a number of off-the-shelf herbal and nutritional supplement products that can fairly reliably delay ejaculation.

Researchers have recently proposed using a dual approach in recognition of the fact that using a medication-only approach is always a temporary solution.

The new approach to manage PE effectively is to combine a short-term "medication-based" approach to allow the user to develop confidence and give enjoy sex during experimentation and personal practice, along with a long-term approach of sensate and techniques training to reduce over-rapid arousal.

Given the tremendous research interest in this subject, it is likely that breakthroughs will be made in the next few years, although they may take longer to come to market.