What Surgery Options Are Available For Premature Ejaculation?

‍What is Premature Ejaculation (PE)?

When ejaculation occurs before, during, or right away after penetration, this condition is considered premature.

The varied causes of premature ejaculation (PE) include:

• Depression
• Stress
• Performance anxiety
• Low level of serotonin
• Prostate inflammation
• Abnormal hormone level
• Relationship difficulty
• Sexual abuse

As treatment depends largely on the cause of PE, it is important to determine the factor responsible for rapid ejaculation.

What Are The Treatment Options for Premature Ejaculation?

Premature ejaculation involves both non-surgical and surgical treatment measures. 

Nonsurgical Measures:

1. Drug therapy 

• Topical therapy - Application of anesthetic lidocaine-prilocaine 5% cream or spray can help in improving ejaculation time and sexual satisfaction
• Phosphodiesterase-5 (PDE-5) inhibitors - They improve premature ejaculation in patients with comorbid erectile dysfunction by creating a perception of more control over ejaculation
• Selective serotonin reuptake inhibitors (SSRIs) - SSRIs specifically increase the serotonin level in the brain that can affect your sexual behavior and cause delayed ejaculation in males.
• Tricyclic antidepressants (TCA) - TCA stops the reabsorption of serotonin so that its secretion in high level will affect the sexual behavior causing delay in ejaculation.
• Tramadol - It improves ejaculatory control and offer more sexual satisfaction. However, its exact mode of action is not clear.

2. Behavioral Therapy 

• Stop-start technique - Stop sexual stimulation before ejaculation, halt till the arousal level reduce, and restart.
• Pause-squeeze technique - In this procedure, pauze when you are about to ejaculate so that you or your partner can squeeze the penis to control the erection
• Pelvic floor exercises - It includes kegel exercises to help strengthen your pelvic floor muscles in order to delay the ejaculation.
• Relationship counseling with the sexual therapist
• Combinational therapy of the above

3. Surgical Measures

• Selective Dorsal Neurectomy (SDN)
• Inner Condom Technique (ICT)
• Cryoablation and Radiofrequency
• Glans Penis Augmentation (GPA) using a Hyaluronic Acid (HA) Gel

Surgery for Premature Ejaculation:

Let us explain the various surgical measures in detail:

Selective Dorsal Neurectomy (SDN)

The dorsal nerve in the penis plays a major role in transmitting sensations from the penis when it comes to the ejaculation reflex. 

People with lifelong premature ejaculation have more dorsal nerves which remain thicker than expected causing more hypersensitivity in the penis.

A permanent surgical procedure like Selective Dorsal Neurectomy (SDN) involves the cutoff of excess dorsal nerves which helps in desensitizing the penis, thereby preventing hypersensitivity as well as overexcitement. This procedure also helps in extending the ejaculation duration and improving sexual perseverance following penetration. 

A 2020 systematic review study reported that SDN is effective for patients with premature ejaculation which can significantly prolong the duration of ejaculation.

Inner Condom Technique (ICT)

This technique involves the use of an inner condom made up of acellular dermal matrix (ADM), a kind of soft tissue support. It was implanted inside the penis to reduce penile skin sensitivity, which can help in extending the ejaculation.

A 2019 study reported that this ICT surgical procedure was found to be effective and safe in achieving a moderate increase in ejaculation duration without any adverse perioperative and psychosexual complications.

Cryoablation and Radiofrequency

The dorsal penile nerve is the sensory nerve for the penis. The stimulation for erection is transmitted through the dorsal nerves of the penis. Hence, the principle of this surgical procedure is to target these sensory dorsal penile nerves to significantly reduce penile sensitivity.

It is a minimally invasive procedure performed on the dorsal nerves of the penis to decrease hypersensitivity and the response to sexual input signals. 

Cryoablation involves freezing and destroying the target cells. Similarly, radiofrequency involves delivering electromagnetic waves to the dorsal nerves.

A 2013 clinical study reported that cryoablation is a safe, feasible, and single-day outpatient procedure for PE treatment. Similarly, a 2021 study revealed that radiofrequency could be a hopeful treatment in patients with lifelong PE.

Glans Penis Augmentation (GPA) using a Hyaluronic Acid (HA) Gel

In this procedure, the hyaluronic acid filler is injected slowly below the superficial layer of the penis using a long blunt-tipped tube. This filler works as a bulking agent forming a barrier between the dorsal penile nerve (the sensory nerve for the penis that aids in ejaculation) and external stimulation.

This procedure also aims at reducing hypersensitivity, thereby controlling the possibility of experiencing premature ejaculation during sexual activity. 

A 2019 study involving the treatment of premature ejaculation with HA injections on the top of the penis revealed an improvement in circumference and volume. These improvements significantly prevented premature ejaculation and increased sexual satisfaction in the participants and their respective partners. 

What are the Risks of Surgical Treatments against Premature Ejaculation?

Although surgery has many proven benefits, it is not practiced successfully in many countries. Even the 2010 International Society for Sexual Medicine (ISSM) guidelines do not recommend Selective Dorsal Neurectomy as well as Glans Penis Augmentation for treating premature ejaculation.

The reason is surgery might increase the risk of permanent loss of sexual function. In fact, surgical procedures like SDN were linked with the recurrence of pain, psychotic episodes, premature ejaculation, erectile dysfunction, penile curvature, etc., although the probability was less than 10 percent.

A Word from Noah

As mentioned already, premature ejaculation is quite common among males. The above treatments can help you manage this condition. 

To start with, consult the doctor right away. After assessing your condition and medical history, they will recommend the most appropriate treatment that works for you.

Here at Noah, our doctors are well equipped with the knowledge to figure out the right treatment for your premature ejaculation problem. 

So, don’t be shy with your doctor. Make sure to fix this problem right away.