Premature Ejaculation Surgery: The Options

Premature ejaculation (PE) happens. In fact, it’s the most common male sexual disorder, and it’s thought to affect 30 percent to a whopping 75 percent of men. While the exact cause of premature ejaculation is unknown, some treatments can help you last longer in bed. One of those treatments is premature ejaculation surgery.

Sexual dysfunction is a complicated issue to treat. While some surgeries are effective, it’s important to know that it should always be a last option after other proven treatments, like exercises and antidepressants, have failed.

Read on to find out the surgery options for PE, the risks, and the alternative treatments to consider.

Premature ejaculation — also known as early ejaculation or rapid ejaculation — can lead to stress, anxiety, and low self-esteem, so there are many reasons you may want to have surgery to treat it.

Some men may ejaculate less than a minute into sexual intercourse — or even before penetration — so surgery can really upgrade their sex lives. PE may be distressing for you and your partner, affect your quality of life, and even cause relationship problems.

By the way, the average time before ejaculating is five to seven minutes, despite what you might hear.

If PE is a temporary problem, you may turn to treatments like medication and lifestyle changes (more on those soon). But if you have ongoing or lifelong premature ejaculation, riskier treatments like surgery could make a difference to your happiness — both in and out of the bedroom.

You may also turn to surgery if PE treatments like medication and therapy haven’t worked for you or if the side effects are too severe. For example, PE meds may affect your libido and require constant use, while topical treatments can cause numbness in both parties. Surgery can help you avoid these adverse effects.

When it comes to surgery for premature ejaculation, you’ve got a few options, some of which are more intensive than others.

Here are the most common surgical treatments for PE.

Selective Dorsal Neurectomy

Selective dorsal neurectomy (SDN) is a surgical treatment in which a surgeon cuts the nerves in your penis.

A nerve called the penile dorsal nerve helps transmit sensations from the penis and plays a role in ejaculatory reflexes. It’s been found that men with lifelong PE have more branches of the penile dorsal nerve than men without ejaculation problems.

The more nerve branches you have, the more sensitive your penis might be — and the more likely you are to experience premature ejaculation.

During the SDN procedure, a surgeon will cut some of these nerve branches. This reduces hypersensitive sensations and excitability, helping you last longer before ejaculating.

Clinical observations have shown that SDN can help men with lifelong PE go from lasting less than a minute to more than six and a half minutes before ejaculating during penetrative sex.

The effect is permanent, with no medications or special pre-sex measures needed.

Inner Condom Technique

The inner condom technique involves implanting a “condom” made of acellular dermal matrix (ADM) under the skin of the penis. The ADM condom helps you last longer by reducing sensitivity in the skin of the penis.

One study looked at 20 men who underwent the inner condom technique procedure. Researchers found the treatment increased the average time to ejaculation from about 40 seconds to about two and a half minutes.

ADM is made from the same material as human skin and is used in lip augmentation, breast reconstruction, and other plastic surgeries, so it’s safe to implant within the body.

The above study found no serious complications or psychosexual effects, and men could get back to doing their thing in the bedroom six weeks after surgery.

Cryoablation and Radiofrequency

Cryoablation is a procedure where body tissue is blasted with cold. Radiofrequency, on the other hand, uses high-frequency waves to blast tissue. When targeted at the dorsal nerve, both can treat PE by reducing hypersensitivity in the penis and lessening response to sexual input signals.

Radiofrequency has been shown to increase sex time before ejaculation from 18.5 seconds to two minutes and 20 seconds after three weeks of treatment. There are usually no erection problems, numbness, or pain after the procedure.

Research into cryoablation has found that it can increase the time men last before ejaculating during sex from about 55 seconds to more than four minutes one week after treatment. However, there are diminishing returns. After 90 days, men can last about three minutes; a year later they can last about a minute and a half.

We also have to caution that, after treatments, four out of 24 participants in this research got less hard when erect. However, two of them spontaneously recovered, and two recovered after taking a PDE-5 inhibitor, a type of erectile dysfunction drug.

Hyaluronic Acid (HA) Gel Glans Penis Augmentation

You might have heard of hyaluronic acid (HA) for skincare, but it also has a role in the bedroom. When injected into the penis, HA can increase the volume and circumference of the penis, acting as a bulking agent and blocking signals to the dorsal nerve so you can last longer.

A 2019 study looked at 20 men who had HA injections into the tip of their penises. The men lasted longer during sex, and at a six-month follow-up, both the men and their partners rated their satisfaction with their sexual performance higher than before the procedure — with no adverse effects.

Combined treatments might be even more effective. Another study, this one from 2004, looked at groups of men with PE who got either a dorsal neurectomy, a dorsal neurectomy with HA injections, or just HA injections.

Post-surgery, all three groups lasted longer in the bedroom. But the group that received both dorsal neurectomy and HA injections went from lasting under two minutes to almost five and a half minutes, the longest time of any trial group.

HA is a natural chemical found in various human tissues, including the skin, eyes, and connective tissue. Since it’s found in the human body, there’s less chance you’ll have a bad reaction to it than from some other treatments.

As with all types of surgery, PE surgical procedures have risks. But one of the biggest problems is a lack of research.

Studies into premature ejaculation surgeries suggest the treatments are safe and effective, but there’s not enough research to say for sure.

Specifically, there’s a lack of large randomized controlled trials with long-term follow-ups, which means the International Society of Sexual Medicine can’t endorse selective dorsal neurectomies or HA injections as PE treatments.

And there are other potential problems you need to know about.

A selective dorsal neurectomy is invasive and it isn’t a sure fix. In fact, PE comes back in 10 percent of patients after the procedure. It can also cause pain, erectile dysfunction, penile curvature, psychotic episodes, and tingling in the tip of the penis — and not the good kind.

When it comes to hyaluronic injections, there’s a risk of a bad reaction to contamination in the injections and tissue death from restricted blood flow caused by poorly delivered injections.

Surgery isn’t your only option if you’re battling premature ejaculation.

There are topical treatments, PE medications, and at-home techniques to treat the condition.

Topical PE treatments

Topical PE treatments include:

• Benzocaine

• Prilocaine

• Lidocaine

These treatments work by reducing penis sensitivity. You can buy them in many forms, including creams, gels, wipes, and delay sprays, both over the counter and online.

Topical products are less invasive than surgery, but you may need to use them every time you have sex. Creams and gels can be messy, and you’ll need to use a condom or wipe them off before penetration so they don’t affect your partner.

Medications for PE

No medications are approved by the Food and Drug Administration (FDA) specifically to treat PE. However, some medications are prescribed off-label as PE pills to treat premature ejaculation, including:

• Viagra® (sildenafil)

• Paxil® (paroxetine)

• Zoloft® (sertraline)

If you have both PE and erectile dysfunction, your healthcare provider may recommend PDE5 inhibitors. This class of medication includes sildenafil, vardenafil, tadalafil, and avanafil.

You may also be prescribed a combination of treatments. For example, a 2019 systematic review and meta-analysis found paroxetine combined with tadalafil or behavioral therapy was more effective at treating PE than paroxetine alone.

Medications are generally effective, but they aren’t perfect. Depending on your situation, you might experience some mild side effects, but those may be more tolerable than full-on surgery.

You can learn more about one popular PE drug in our guide to sildenafil for PE, and speak to a healthcare provider or urologist to find out the best treatment for you.

Techniques for PE

There are a few PE exercises you can do at home to control ejaculation. They’re not necessarily long-term fixes, but they can help in the moment and may be worth trying before turning to the more extreme surgery option.

Here are some tips for controlling ejaculation during sexual activity:

• The stop-start technique. This involves hitting pause on your sex sesh just before you climax, waiting until the urge to ejaculate goes away, and then picking up where you left off. Practice a few times and learn to recognize what it feels like right before you’re going to climax so you can stop things in time.

• The squeeze technique. As the name suggests, this exercise involves squeezing. Right before orgasm, squeeze the tip of your penis with your index finger and thumb. This should decrease arousal levels and give you some more time.

• Use a condom. If you don’t already, try having sex with a condom. It can reduce sensitivity, helping you last longer.

• Try masturbating before sex. If you know there’s a chance you may have sex that evening, try masturbating a few hours beforehand. You may find you last longer when it’s time for round two.

• Distract yourself. Your partner might not love this one, but thinking about something else during sex can help delay ejaculation. There’s a balance, though — you don’t want to distract yourself so much that you lose your erection.

• Talk to your partner. Having an open and honest chat with your partner about sexual problems can relieve some of the stress and reduce any lingering performance anxiety that might get in the way of a good experience. You can also brainstorm PE-stopping ideas together instead of just surprising them with the squeeze technique. We’ve covered more advice in our guide to dealing with PE in a relationship.

• Do pelvic floor exercises. Research has found that 12 weeks of pelvic floor rehab can help some men with lifelong premature ejaculation gain control of their ejaculatory reflex.

PE can be mental, which means psychological factors might be at play. If you’re dealing with anxiety, depression, or another mental health issue, speak to a healthcare provider. The treatment of premature ejaculation may require treating the root cause first.

For more science-backed advice, check out our guide on how to stop premature ejaculation.

When you climax early, it can get frustrating. Thankfully, premature ejaculation can be treated, and surgery is just one of your options.

Here’s what you need to know.

• There are many surgical treatments for PE. They include selective dorsal neurectomy, the inner condom technique, cryoablation, radiofrequency, and hyaluronic acid injections.

• Surgeries seem to be safe. But more research needs to be done and there is a risk of complications. Surgery may be right for you if PE pills and topical treatments haven’t worked.

• Consider other PE treatment options. From wipes and sprays to medications like Viagra, other PE treatments exist. You might want to give these a go before going under the knife.

If you’re considering meds, you should speak with a licensed healthcare provider who can recommend the best course of action to help you stay in the action for longer and connect you with premature ejaculation treatments online.