In spite of its high prevalence and long history, the ambiguity regarding the definition, epidemiology and management of premature ejaculation continues. Topical anesthetic creams and daily or on-demand selective serotonin reuptake inhibitor (SSRI) treatment forms the basis of pharmacotherapy for premature ejaculation today, in spite of low adherence by patients. Psychotherapy may improve the outcomes when combined with these treatment modalities. Tramadol and phosphodiesterase type 5 inhibitors have a limited role in the management of premature ejaculation.

                     The American Psychiatric Association defined premature ejaculation and, contrary to previous versions of this manual, it included the parameter of approximately one minute intravaginal ejaculatory latency time (IELT) to determine status of premature ejaculation.They also listed potential exclusionary conditions, to include nonsexual mental disorders, severe relationship distress or other significant stressors and substance/medication use or other medical disorders, which may result in early ejaculations. Historically, premature ejaculation was considered to be a psychological or partner-related condition due either to anxiety or to conditioning towards rapid ejaculation based on rushed early sexual experiences [6,7]. Therefore, psychotherapy was the initial treatment modality proposed for premature ejaculation, although its utility is limited in today's practice.

               Hypersensitivity of the glans penis is another one of the proposed etiological factors underlying the pathophysiology of premature ejaculation.Therefore, the use of topical anesthetics to diminish the sensitivity of the glans penis was one of the first pharmacological treatment alternatives for premature ejaculation.

             Disregulation in central serotonergic neurotransmission is hypothesized as one of the etiologic factors underlying premature ejaculation.Serotonin is the most important neurotransmitter in the control of ejaculation and its impact on ejaculation has been demonstrated in animal and human models.The introduction of tricyclic antidepressants and SSRIs for the treatment of premature ejaculation has revolutionized our understanding of this problem and completely altered its management. These drugs block the axonal re-uptake of serotonin from the synaptic cleft and increase 5-HT neurotransmission through enhanced stimulation of post-synaptic membrane 5-HT receptors. Today, most premature ejaculation patients are treated either with on-demand SSRIs (dapoxetine) or with daily dosing of paroxetine, clomipramine, sertraline, fluoxetine or citalopram.Daily treatment with paroxetine 10-40 mg, clomipramine 12.5-50 mg, sertraline 50-200 mg, fluoxetine 20-40 mg, and citalopram 20-40 mg is usually effective in delaying ejaculation.

                  Dapoxetine is a rapid acting SSRI with a short half-life that was the first approved oral medication for the treatment of premature ejaculation. Its pharmacokinetic profile enables its on-demand use. In several well-controlled studies, dapoxetine 30 mg or 60 mg (taken 1-2 hours before intercourse) is shown to increase IELT 2.5- and 3.0-fold and improve the patient-reported outcome measures