Premature ejaculation is by far the most common ejaculatory disorder, with rates among US men believed to be as high as 30 %, or even greater. Rapid ejaculation may be treated pharmacologically with a variety of different medications which act either centrally or locally to retard the psychoneurological control of ejaculation and subsequent orgasm. Antidepressants, particularly members of the selective serotonin reuptake inhibitors (SSRI) class, will retard ejaculation significantly. Historically, attempts to explain the etiology of premature ejaculation have included a diverse range of biological and psychological theories. Recently, it is postulated that the persistent occurrence of IELTs of less than 1 minute in men with lifelong PE results from a combination of polymorphisms of the serotonergic transporter and receptors, and other neurotransmitters and/or receptors. About half of our patients showed an excellent response to paroxetin where the majority of the patients were SS and SL genotypes. Yet, such response was unrelated to the genotype.