Introduction: Premature ejaculation is widely recognized as the most common male sexual dysfunction, affecting up to 30% of the sexually active male population. As a taboo subject, it often goes unreported. Premature ejaculation has a complex aetiology, encompassing both congenital and acquired causes, with psychosocial and biological factors playing a significant role. Objectives: The main aim of this article was to analyse the potential psychological factors contributing to the development of premature ejaculation and to emphasize the need for a comprehensive clinical interview to properly differentiate the underlying causes of the dysfunction. Methods: This article is a review based on the analysis and synthesis of available scientific literature and clinical guidelines on the epidemiology, aetiology, diagnosis, and treatment of premature ejaculation. The focus was on factors contributing to acquired premature ejaculation, with particular emphasis on psychological mechanisms. Results: The aetiology of acquired premature ejaculation has been shown to be multifactorial and characterized by the interaction between biological and psychological factors. Sympathetic nervous system overactivity and an impaired excitation/inhibition balance is the common denominator of these mechanisms. Furthermore, we found a significant correlation between premature ejaculation and poor mental health. Unfortunately, discrepancies in diagnostic timing criteria hinder standardization. Causal treatment should be used for acquired premature ejaculation, and if insufficient, pharmacotherapy should be initiated. Conclusions: Premature ejaculation is a sexual dysfunction requiring an interdisciplinary and personalized approach. It is crucial to distinguish acquired from lifelong premature ejaculation based on a detailed clinical interview. Psychotherapy is an essential component of therapy, regardless of the aetiology of the dysfunction. Openness to this topic and interdisciplinary care are key to improving patients’ quality of life.