الفهرس 
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Abstract
PE is the commonest sexual dysfunction in men, with reported prevalence estimated to be 4–39% (Hyun, et al., 2002).
The majority of men seeking medical treatment for complaints of PE ejaculate within 1 min (Waldinger et al., 1998).
Since the beginning of the last century, PE has been regarded as an expression of an unconscious psychological conflict. It has also been attributed to many urological disturbances, and many different treatments have been recommended over the years (Waldinger, 2004).
PE can be classified into two types , primary (lifelong) PE and secondary (acquired) PE, respectively (Godpodinoff, 1989), and were included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IVTR), which is the American Psychiatric Association (APA) classification system of mental disorders (American Psychiatric Association, 2000).
Men with PE report significantly more emotional distress, loss of self steem, anxiety, depression, and social isolation than men without PE (Symonds et al., 2003).
The etiology of premature ejaculation has included a diverse range of biogenic and psychological theories. Most of these proposed etiologies are speculative and not evidence based. Psychological theories include the effect of early experience and sexual conditioning, anxiety, sexual technique, the frequency of sexual activity, and psychodynamic explanations. Biogenic explanations include evolutionary theories, penile sensitivity, central neurotransmitter levels and receptor sensitivity, degree of arousability, the speed of the ejaculatory reflex, and the level of sex hormones (Broderick, 2005).
In order to diagnose PE, physicians are urged to consider sixth prominent factors: either the reported (felt) or measured IELT and the five subjective patient assessments: control over ejaculation; satisfaction with intercourse, personal distress, anxiety and interpersonal difficulties relating to the condition (Waldinger et al., 2005& Patrick et al., 2005).
Managing PE has been a challenge for physicians, until very recently there was are no FDA-approved therapies for the condition (Payne and Sadovsky, 2007). Now dapoxtine HCL has recently been approved in several European countries (Patel and Hellstrom, 2009).
Lifelong PE should be treated with drugs that strongly delay ejaculation. It is a matter of debate whether additional counseling is always needed for these men; alot of these men will manage without additional counseling. However, clinicians should take time to talk with these men, to inform them about the current knowledge of lifelong PE, and to regularly check their well-being, particularly when using SSRIs on a daily basis (Waldinger, 2007).
On the other hand acquired PE treated with drugs that deal with the underlying medical pathology, or psychotherapy to treat underlying psychologic pathology. Both lines can be used with or without additional drug treatment options like SSRIs or topical anesthetics (Waldinger, 2007).
Behavioural, cognitive, and sex therapy approaches have been used to treat PE. Although these strategies have demonstrated some short-term success, they are associated with substantial relapse (Eardley, 2007).
Sex therapy methods for PE have shown good efficacy, and often allow the man to learn to recognize and respond to treat his problem. However, they require considerable commitment and practice from the individual and his partner, and follow-up data have shown that their efficacy tends to decrease over time (Waldinger et al., 2004).
Many pharmacological methods are available for treatment of PE However; none of them have been approved by the FDA. Instead, PE is treated with the off label use of antidepressants, topical anesthetics and PDE-5 inhibitors (Althof, 2006). Only Dapoxetine has recently been approved in several European countries (Patel and Hellstrom, 2009).
Recognition of an underlying neurobiologic basis in the aetiology of PE has led to the evolution of pharmacotherapies to help manage the disorder (Porst, 2008).
Some investigators have evaluated patients with PE by penile biothesiometry and have demonstrated that patients with primary PE have penile hypersensitivity and can be treated by desensitizing preparations (Xin et al., 1996).
Topical medications, first described in 1943 are the oldest form of pharmacological therapy (Shapiro, 1943). The aim was to treat penile hypersensitivity, one of the purported causes of PE, by applying local anaesthetics in a cream, gel or spray formulation to decrease penile sensitivity (Porst, 2008).
Since the mid-1990s, daily treatment or combined daily treatment with on-demand use of some SSRIs and/or clomipramine has become the first choice of treatment (Waldinger and Olivier, 2004).
Some new trends for treatment of PE are still experimental like penile desensitization and dorsal neurectomy either surgically or via pulsed radiofrequency (McMahon, 2007).