Premature Ejaculation Surgery: The Options

Katelyn Hagerty FNP

Reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Published 05/29/2021

Updated 05/30/2021

Premature ejaculation is one of the most common forms of sexual dysfunction. In a worldwide line-up of men, there's a good chance about 30% of the population will have dealt with some form of PE at different points in their lives.

Premature ejaculation makes for a lot of uncertainty and discomfort during sex. 

This is why finding suitable premature ejaculation treatments for this condition is usually a top priority for most men, and sometimes those remedies include  surgical interventions.

Here’s how surgery for premature ejaculation can help, along with possible causes of the condition.

What Is Premature Ejaculation?

Ejaculation is considered premature when it happens before, during or very shortly after penetration. 

Because people are different and have unique sexual experiences, it's hard to define a precise amount of time that counts as premature. 

A popular measurement is where ejaculation occurs less than two minutes after penetration, or when it occurs before penetration even takes place.

As expected, PE usually happens without either party intending it, and can be distressing to one or both involved.

Premature ejaculation may be lifelong, with sex always disturbed by a chance of early ejaculation. 

Other times, it may be an acquired condition after a period of achieving normal ejaculation following intercourse.

You may also experience premature ejaculation with certain partners or forms of stimulation, and in these  particular cases, the issue is known as situational PE. 

If ejaculation routinely comes too soon regardless of partner, situation or type of stimulation, it is known as generalized PE.

Causes of Premature Ejaculation

If you consistently find it difficult to hold off ejaculating during sex, this difficulty may be traced to a number of psychological or biological factors. Some of these include:

  • Stress

  • Depression

  • Sexual abuse

  • Poor body image

  • Performance anxiety

  • Relationship difficulties

  • Low levels of serotonin

  • Abnormal hormonal levels

  • Inflammation of the prostate

Because treatment is largely dependent on the cause of premature ejaculation, it's very important to identify what may be responsible for early ejaculation during intercourse.

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Surgery for Premature Ejaculation

If your sexual experience is usually cut short by premature ejaculation, treatment measures like medication and psychotherapy are usually recommended to provide relief. 

These measures may however provide only short-term relief. 

And while there are limited studies detailing how effective therapy is for managing PE, making the decision to stop using prescribed pills, can leave you vulnerable to early ejaculation during sex. 

Other times, therapy and medication may simply be ineffective for managing PE.

In cases where usual treatment methods are unable to improve sexual function, surgery for premature ejaculation may be a viable option. 

This treatment is particularly recommended to reduce hypersensitivity of the penis—a common mechanism that promotes early ejaculation. 

Here are four types of  surgical treatments for premature ejaculation:

Selective Dorsal Neurectomy (SDN)

It may not be immediately obvious from the surface, but within the penis are a number of nerves that help with feeling and communicating sensations. 

In particular, the dorsal nerve of the penis helps  transmit sensations from the penis and its very sensitive head (more commonly known as the tip). 

This nerve also plays  an important role when it comes to ejaculatory reflexes.

When people with lifelong premature ejaculation were examined, it turned out they had more dorsal nerves which also happened to be thicker than expected. 

These features are believed to cause hypersensitivity in the penis, upping the chances of premature ejaculation during sex. 

A selective dorsal neurectomy helps to desensitize the penis by preventing hypersensitivity and overexcitement. 

This procedure may also help extend the timing for ejaculation and can improve sexual perseverance following penetration. 

To achieve this feat, SDN looks to cut off excess dorsal nerves to encourage reduced sensitivity during sex.

In a trial where men with redundant foreskins underwent circumcision and SDN, those with lifelong premature ejaculation discovered that they were able to control their ejaculation better. 

They also found that they could last longer following penetration.

A selective dorsal neurectomy is a permanent procedure and is often preferred to medications that require constant use.

Inner Condom Technique

Because hypersensitivity is a recognized cause of premature ejaculation, this PE treatment also aims to reduce sensitivity in the penis.

To achieve this, an inner condom made of acellular dermal matrix (ADM) is implanted inside the penis. 

ADM is derived from the same material the skin is made from, making it compatible with human use. 

This is added to the fact that it accommodates growth within the penis without leading to an immune response from the body. 

Implanting ADM into the penis is intended to reduce skin sensitivity, as well as the sensitivity of the penis membranes—which can help prolong ejaculation following penetration in people with PE.

A study carried out on 20 men with premature ejaculation saw the participants implanted with inner condoms. 

This procedure was found to be safe and effective, helping to achieve a moderate increase in ejaculation time in the patients.

Cryoablation and Radiofrequency

Cryoablation is a term you may have heard in relation to cancer treatment, as the process can kill urinary tumors by freezing and destroying them.

By performing this treatment on the dorsal nerves of the penis, it's possible to reduce hypersensitivity in the penis, as well as the response to sexual input signals.

Pulsed radiofrequency is commonly used to manage pain. 

However, this minimally invasive procedure is also useful for regulating the activities of the dorsal nerves of the penis, as well as their sensitivity. 

It achieves this by delivering electromagnetic waves to the nerves.

Hyaluronic Acid (HA) Gel Glans Penis Augmentation

Hyaluronic acid may get most of its attention for anti-aging benefits, but this acid also holds promise for helping to relieve premature ejaculation. 

This benefit is thanks in part to the little-known fact that HA is a natural component of the human body, and is found in the skin, eyes, and connective tissue

This in turn permits its application as a safe filler for the penis, leaving little risk of producing an immune reaction from the body.

When a hyaluronic acid filler is applied into the penis, the compound acts as a bulking agent, creating a barrier between the dorsal nerve and external stimulation. 

This can help to reduce hypersensitivity, controlling the chances of experiencing premature ejaculation during sex.

In a study that lasted eight months, 20 men experiencing premature ejaculation were treated with hyaluronic acid injections. 

These injections were applied to the top of the penis causing an improvement in volume and circumference. 

The effects successfully prevented premature ejaculation and increased sexual satisfaction in the participants and their partners by the time the study ended.  

Risks of Surgical Treatments for Premature Ejaculation

Despite having proven benefits for managing premature ejaculation, surgical treatments are not popularly practiced in most countries. 

In fact, the International Society for Sexual Medicine (ISSM) does not recommend selective dorsal neurectomy or penis augmentation with hyaluronic acid for treating PE. 

Surgical treatments are particularly disapproved of because they can increase the risk of  permanent loss of sexual function. 

This is coupled with the lack of studies and data on effectiveness and safety.

Some surgical procedures like SDN have been linked with the recurrence of premature ejaculation, pain, curving in the penis, erectile dysfunction and psychotic episodes.. 

Surgical procedures have also sometimes caused poor blood flow to the tissue, which can lead to cell death. 

This condition is usually caused by improperly  administering the injection for the procedure.

Despite these risks, however , surgery for premature ejaculation is a popular treatment option, especially in countries like Korea and China.

Other Treatments for Premature Ejaculation

While the jury is still out on the safety and effectiveness of surgery for PE,  other treatment methods have been popularly accepted to manage this condition. 

They include different practices such as masturbating before sex and the stop-start technique among others.

Premature ejaculation may also be managed by trusted prescription medication such as:

Topical treatments that contain lidocaine spray are also used to manage cases of premature ejaculation, by helping to reduce sensitivity.

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Knowing If Premature Ejaculation Surgery Is Right for You

Finishing early is one of the very last things anyone wants to happen during sex, which is why treatment options are quickly sought out in cases of premature ejaculation.

While many methods exist to manage this condition, surgical intervention is emerging as a PE solution.

This may be via the inner condom technique, selective dorsal neurectomy, cryoablation or through penis augmentation.

If you’re looking for ways to control ejaculation during sex—but aren’t quite ready for a surgical procedure or the side effects that may result from it, read our guide on less-invasive methods of stopping premature ejaculation.

12 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Gajjala, S. R., & Khalidi, A. (2014). Premature ejaculation: A review. Indian journal of sexually transmitted diseases and AIDS, 35(2), 92–95. Retrieved from:
  2. Crowdis M, Nazir S. Premature Ejaculation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Retrieved from:
  3. Kozacioglu, Z., Kiray, A., Ergur, I., Zeybek, G., Degirmenci, T., & Gunlusoy, B. (2014). Anatomy of the dorsal nerve of the penis, clinical implications. Urology, 83(1), 121–124. Retrieved from:
  4. Liu, Q., Li, S., Zhang, Y., Cheng, Y., Fan, J., Jiang, L., Li, S., Tang, Y., Zeng, H., Wang, J., & Zhu, Z. (2019). Anatomic Basis and Clinical Effect of Selective Dorsal Neurectomy for Patients with Lifelong Premature Ejaculation: A Randomized Controlled Trial. The journal of sexual medicine, 16(4), 522–530. Retrieved from:
  5. Hu, Q. B., Zhang, D., Ma, L., Ng, D. M., Haleem, M., & Ma, Q. (2019). Progresses in pharmaceutical and surgical management of premature ejaculation. Chinese medical journal, 132(19), 2362–2372. Retrieved from:
  6. Walker K, Basehore BM, Goyal A, et al. Hyaluronic Acid. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Retrieved from:
  7. Jeong, H. G., Ahn, S. T., Kim, J. W., Seo, K. K., Lee, D. S., Uh, H. S., Kim, J. J., & Moon, D. G. (2018). Practice Patterns Among Korean Urologists for Glans Penis Augmentation Using Hyaluronic Acid Filler in the Management of Premature Ejaculation. Sexual medicine, 6(4), 297–301. Retrieved from:
  8. Anaissie, J., Yafi, F. A., & Hellstrom, W. J. (2016). Surgery is not indicated for the treatment of premature ejaculation. Translational andrology and urology, 5(4), 607–612. Retrieved from:

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.