Premature ejaculation (PE) is a frequent male sexual complaint. Its occurrence does not automatically imply the existence of a male sexual disorder. The current DSM definition of PE has a low-positive predictive value with a high associated risk for false-positive diagnoses of PE. A new classification in four well-defined PE syndromes has recently been proposed for the pending DSM-V. According to this new classification there are different pathophysiologies, etiologies, and treatments of PE dependent on the underlying PE syndrome. Some types are particularly neurobiologically or medically determined and need drug treatment; other types, which are mainly psychologically determined, need psychotherapy or both. Moreover, according to the proposed new classification it is likely that only a small number of men with complaints of PE suffer from a neurobiologically determined PE disturbance.