Surgery for premature ejaculation

Premature Ejaculation

Premature ejaculation (PE), also known as rapid ejaculation, is a very common condition in which a man ejaculates earlier than he would like to. This can be frustrating problem for both parties and can even lead to divorce. Among sexual problems, premature ejaculation is the most frequent one.

A survey showed that among several thousands of man, around 10 % experience this problem occasionally. Premature ejaculation has higher incidence rate among younger males since older men have better control.

Premature ejaculation is hard to define since intercourse can last shorter in one couple then in another. One research reported that average lasting time of men suffering from premature ejaculation was 1.8 minutes. Unaffected men lasted approximately 7.3 minutes. According to professor Waldinger, men who can’t last 90 seconds inside the vagina suffer from premature ejaculation. Also, when a man feels that the climax is happening too early, that means that he has got some degree of premature ejaculation.

Severe form of premature ejaculation is characterized by ejaculation before beginning of intercourse. Such condition can be very frustrating for men and can ruin their self-confidence. It can also be annoying for a woman especially if she plans to conceive.

Causes of Premature Ejaculation

The exact cause of premature ejaculation is unknown. But the cause can have psychological nature which means that early rushed sexual experiences lead to this condition. That can be a situation where a man didn’t want to be discovered so he hurried to reach orgasm. Some consider that the tendency to reach climax quickly can be inherited rather than learnt. Anxiety can also be the cause of premature ejaculation. Men who are nervous, especially about their sexual performance, are more prone to this condition.

Although significant improvements in the treatment of lifelong premature ejaculation have been made through pharmacotherapy, complications still exist. Topical anesthetics may cause numbness in the patient and his partner(s) and their usage are not convenient. SSRIs usually have to last for a long time and treatment cost is high. Additionally, sexual desire may also be inhibited by SSRIs. The side effects on sperm production, transportation, sperm cell membranes, and DNA also have been reported.

Is there a simple way to cure lifelong premature ejaculation? Surgery may be a choice for patients who are resistant to medication treatment. The efforts to explore and find new surgical treatment for premature ejaculation has never stopped. At least three surgical procedures have been reported in the treatment of premature ejaculation:

Selective penile dorsal nerve neurotomy - It was concluded that the number of dorsal nerve branches in patients with lifelong premature ejaculation is positively correlated with penile sensitivity. Theoretically, selective penile dorsal nerve neurotomy may be the solution as it blocks hypersensitive peripheral sexual stimulation signals, inhibits penile hypersensitivity and central excitability, which may help improve ejaculation threshold, and extend intra-vaginal ejaculation latency time. A clinical observation in China reported the effect of selective penile dorsal nerve neurotomy in patients with lifelong premature ejaculation, it showed that the intra-vaginal ejaculation latency time was significantly increased after surgery (0.86?±?0.32?min vs. 6.65?±?3.90?min).
Through a simple surgical procedure, it provides a treatment similar to topical anesthetics. The effect is permanent, no oral medication is needed and no special preparation has to be considered before coitus.

Korean doctors preferred to remove the collateral branch to reduce penile sensitivity and increase the intra-vaginal ejaculation latency time and patient satisfaction. They reported that 81.8% of the patients were satisfied after cutting 2 to 3 lateral branches on both sides in 143 patients, the patients experienced an increase in intra-vaginal ejaculation latency time and a reduction of the vibration threshold without loss of sensation.
Cryoablation and pulsed radiofrequency are established types of minimally invasive techniques for the treatment of urinary tumor, which can kill tumor cells with precision. Some scholars expanded their application based on the hypothesis that performing cryoablation or pulsed radiofrequency on the dorsal nerve reduces hypersensitive peripheral sexual input signals and inhibited penile hypersensitivity.
A prospective study evaluated the efficacy of percutaneous computed tomography (CT)-guided cryoablation in 24 patients on a unilateral dorsal penile nerve in the treatment of symptomatic premature ejaculation. The report showed that intra-vaginal ejaculation latency time was increased from a baseline value of 54.7?±?7.8?s to a maximum of 256.0?±?104.0?s by day 7, to 182.5?±?87.8?s by day 90, and 145.9?±?86.5?s in 1 year.
Glandular augmentation with hyaluronic acid gel - This approach refers to the injection of hyaluronic acid gel into the glans, to build a barrier artificially between the dorsal penile nerve and its external environment. Some authors reported the efficacy of this surgery, but a series of complications such as possible sensory loss were also reported.

✓ Fact confirmed: Progresses in pharmaceutical and surgical management of premature ejaculation Qin-Bo Hu, Dong Zhang, Liang Ma, Derry Mingyao Ng, Maria Haleem and Qi Ma; 2019 Sep 23.

Treatment options for premature ejaculation commonly include sexual therapy, psychotherapy and medications. The most radical treatment option is a surgery for premature ejaculations by which this problem is fixed forever.

It involves penis temporary denervation by intersection. The section is made around glans penis (balanus). This procedure allows prolonging sexual intercourse from 8 to 10 times. With such surgery penis is made insensitive that allows the patient to endure up to 20-30 minutes. Practically, this procedure is a temporary anesthesia that lasts for 6 months. After the surgery, a man can have long intercourse for 6 to 7 months after the penis sensitivity is completely restored.

Unpleasant result of this surgery is that balanus can remain oversensitive after the denervation but this will call for another operation. Also, sensitivity might not be regained fully.

The procedure doesn’t entail after treatment but in case of infections, which rarely occur, recovery will last longer.