Premature ejaculation (PE; early ejaculation or rapid ejaculation) is a common sexual problem affecting about 20-30% of men in the sexually active age group. PE can be of four types: Primary, secondary, natural variable, and subjective PE. Various non-pharmacological and pharmacological treatment options are available to treat PE including Dapoxetine, which is specifically developed for the treatment of PE. In this review, we discuss the pathophysiology and management aspects of PE.

The present study aimed to compare the in vitro fertilizing capacity of frozen-thawed ejaculated and epididymal spermatozoa in order to standardize the semen preparation protocol for camel in vitro fertilization (IVF). Semen samples were collected from 7 Dromedary camels by means of artificial vagina (AV). Ten cauda epididymes were obtained from slaughtered adult camels, isolated, incised and rinsed for obtaining the sperm rich fluid. Ejaculated and epididymal spermatozoa were processed for cryopreservation. Fresh and frozen-thawed ejaculated and epididymal spermatozoa were evaluated for motility, livability, membrane and acrosomal integrities. Frozen-thawed ejaculated and epididymal spermatozoa were used to fertilize camel mature oocytes in vitro. The results showed that, the progressive motility of freshly collected epididymal spermatozoa was significantly (P

Premature ejaculation (PE) that is named as "Sorat-e-Enzal" [ejaculation quickly] in traditional Persian medicine (PM), means to ejaculate sooner than one minute from the start of vaginal penetration, inability to delay ejaculation and distress and suffering during intercourse. Its prevalence has been reported 2.3 to 30 percent.
The aim of this study was to evaluate and compare the causes of premature ejaculation in traditional and conventional medicine and use it to explain more accurate concept of pathophysiology of the disease which provides more appropriate way to achieve therapeutic protocol.
Data collection was based on targeted review of the credible books from traditional medicine such as Canon of Medicine and recent reference books and literatures in urology and psychiatry. The causes of premature ejaculation were obtained by searching keywords such as premature ejaculation and sexual disorders in databases including Pub Med, Science Direct, SID (Scientific Information Database) and also Google Scholar from 2004 to 2016. The causes identified were summarized in a table and the similarities and differences were determined.
At the first look, the causes of premature ejaculation in traditional and conventional medicine seem to be different but more exact comparison showed significant similarities. The effect of six essential factors (named as sette-zarurieh in PM) on PE has been explained in both traditional and conventional medicine.
In conventional and traditional medicine, the diseases of heart, liver, stomach and kidney and also neurological and psychological disorders cited as factors for sexual dysfunction.
Factors related to the penis diseases, metabolic disorders or physiological, anatomical, histological diseases and causes related to sexual gonads have been mentioned in both conventional and traditional medicine. Conventional medicine specifically expresses hormonal causes (hyperthyroidism) whilst Persian medicine exclusively has explained symptoms related to semen liquid in this disorder.
Discussion & This review has categorized fourteen causes for premature ejaculation that are similar in both conventional and Persian medicine in almost all fields.

Premature ejaculation is likely the most common sexual dysfunction in men with a worldwide prevalence of approximately 30%. Epidemiological studies, accurate diagnosis, appropriate treatment and evaluation of clinical trials need a universally acknowledged definition that is also capable of operationalization. Studies have defined premature ejaculation differently. The most widely used definition is the DSM-IV-TR definition. However, the majority of these definitions are authority-based rather than evidence-based, and has no support from clinical and/or epidemiological studies. In this article, 41 articles were examined, various definitions of premature ejaculation were reviewed, definition criteria of it were discussed and classification of this dysfunction was mentioned. The results showed that multidimensional classifications and definitions using various diagnostic criteria, especially objective criteria like IELT are the most appropriate ones.

Varicocele is defined as elongation and enlargement of of veins leaving the testis which join to form the pampiniform plexusis in the scrotum and can influence the testicular function. Testis is the main source of testosterone that any effect on it can affect this hormone too. Premature ejaculation is defined as to reach orgasm before the desired time or ejaculation before or immediately after sex and is determined by proximity and ejaculation before two minutes after intercourse. This study aimed to investigate the effect of varicocele on serum testosterone levels and premature ejaculation. In this case-control study, 38 patients with varicocele and 38 healthy individuals, as controls, were selected and their testosterone levels (blood sample before 11 AM), frequency of ejaculation, despite testicular atrophy, and grade of varicocele were assessed and compared. In patients group 28.9% and in control group 10.5% were suffering from premature ejaculation (P < 0.05). Mean testosterone level was 6.5 ± 1.9 and 7.8 ± 2.1 ng/ml in patients and control groups, respectively. Varicocele grade and testicular atrophy was correlated (05 / 0> P). Despite the testosterone level was lower in patients with varicocele, no significant correlation between testosterone levels and varicocele grade was observed. This study shows a significant relationship between varicocele and premature ejaculation; it seems that in patients with varicocele, testosterone serum level should be measured regularly and And if reduced, to be corrected.

The present study was carried out in order to comparison and investigation of the effectiveness of cognitive-behavior therapy and drug-therapy in treating premature ejaculation men referred to Ahvaz city therapy centers. 39 men with premature ejaculation were selected using structured clinical interview for DSM-TV-TR based on premature ejaculation dysfunction and cut of point in Premature Ejaculation Diagnostic Tool (PEDT). Subjects were assigned groups (cognitive-behavior therapy, drug therapy and control) through sampling random method. Data were collected in three stages (pretest, post test and follow-up) through Premature Ejaculation Diagnostic Tool (PEDT), Sexual Quality of Life Questionnaire-Male and stopwatch. Results of ANCOVA in post-test stage by controlling pre-test showed that cognitive-behavior therapy and drug therapy are significantly efficient on treatment of premature ejaculation. But there is not difference between cognitive-behavior therapy and drug therapy in treatment of premature ejaculation. Results of follow-up stage showed that the effects of cognitive-behavior therapy were stable but effects of drug therapy were not stable. Also, the effects of cognitive-behavior therapy were more stable than drug therapy. Cognitive-behavior therapy and drug therapy have appropriate efficacy in the treatment of men suffering from premature ejaculation significantly but effects of Drug Therapy are not stable.

Premature ejaculation is the most common disorder in men. Different methods have been proposed to recover this problem while, often most of them have been unsuccessful in practice due to multiple after comes.
Our study aimed to compare the effect of combination extracts of “Boswellia serrata” and “Lavandula angustifolia” and placebo on recovery of premature ejaculation.
Both plants were extracted and formulized for administration. Choosing patients was based on medical standards, questionnaire of premature ejaculation and standard criteria test. The proper cases were categorized randomly in one of three groups under study regarding DSM5 criteria. The number of samples in each group has hypothesized 30 and investigation continued for two month for all groups: oral extract administered group, placebo treatment group and no premature treatment as a control group. The scores gained form fast ejaculating questionnaire were assessed in early stages of treatment (pretest), one month after treatment (posttests), and two month after treatment (fallow).
The results showed that combination therapy with plant extracts was significantly potent to reduce premature ejaculation performance scores index than placebo and control group; the F value calculated for assessing drug effect in recovery of premature ejaculation in various stages will be meaningful in the level of 0.05 (F=14.23, P It seems that, compounds of “Boswellia serrata” and “Lavandula angustifolia” extract can be effective in recovery of premature ejaculation opioid addicted patients. The mechanism and effective ingredients causing this effect are needed to be further investigated.

Male sexual disorder includes hypoactive sexual desire disorder, male erectile disorder, premature ejaculation and male orgasmic disorder. Premature ejaculation is the most common problem. Premature ejaculation could have an effect on the various aspects of the quality of life including emotional happiness, interpersonal relationship, and social behavior. One of the important aspects of premature ejaculation is definition of this problem and explanation to the individuals. Currently, various treatments are available for premature ejaculation consistent with psychological/behavioral management and pharmacotherapy. Serotonin Specific Reuptake Inhibitors (SSRIs) especially dapoxitin, are first-line pharmacotherapy; however tramadol might be used for unresponsive premature ejaculation. New therapeutic approaches are being researched including modafinil, botulinum toxin, acupuncture and circumcision.

Comparative study of therapeutic effects of two medicinal procedures of fluoxetine 3 hours before coitus and each 12 hours, and declining symptoms of SSRI drugs in patients through decreasing dosage and therapeutic procedure in patients refer to 501 hospital and private clinic The procedure of this study is based on non stochastic clinical test without quasi drug group and a comparison from therapeutic effect and symptoms of two medicinal procedures of fluoxetine 4 hours before coitus and each 12 hours in premature ejaculation treatment in 88 patients refer to 501 hospital and private clinic. Patient were divided into two groups in peradventure manner. In first group, it is prescribed 20mg of fluoxetine daily 4 hours before coitus in 39 patients and in 2nd groups group, it is prescribed 20mg of fluoxetine each 12 hours before coitus in 49 patients. Finally it was analyzed data in SPSS software. The average of ejaculation duration in fluoxetine group 4 hours after coitus before treatment was 139.97 Sec. that after 4 weeks of hospitalization reached to 225.25 and p.v: 0.0000 and after 8 weeks to 261.153 Sec. and p.v: 0.0000 and in compare with ejaculation duration between 4th and 8th weeks it gained p.v: 0.003. The average of ejaculation duration in fluoxetine group 12 hours after coitus before treatment was 107.04 Sec. that after 4 weeks of hospitalization reached to 294.08 and p.v: 0.0000 and after 8 weeks to 324.08 Sec. and p.v: 0.0000 and in compare with ejaculation duration between 4th and 8th weeks it gained p.v: 0.029. In comparing ejaculation duration between 2 groups’ fluoxetine 4 hours before coitus (t=225.25) and each 12 hours (t=294.08) in 4th week after treatment it gained p.v: 0.03. In comparing ejaculation duration between 2 groups’ fluoxetine 4 hours before coitus (t=261.153) and each 12 hours (t=324.08) in 8th week after treatment it gained p.v: 0.0000. Symptom measure in fluoxetine group 4 hours before coitus 12.8% and symptom measure in fluoxetine group 12 hours before coitus 44.9% and p.v: 0.001. In this study, both drug method improved ejaculation duration but in 2nd group it was considerably higher than the 1st one. Also from symptom point of view, symptoms in fluoxetine group each 12 hours was considerably higher than group with 4 hours before coitus.