Premature Ejaculation Surgery: The Options
Reviewed by Katelyn Hagerty, FNP
Written by Vanessa Gibbs
The lights are low. The sexy jams playlist is on. You’ve just started getting it on and then it happens: you climax. Too soon for your comfort.
The exact cause of premature ejaculation is unknown, but there are treatments out there to help you last longer in bed. One of those treatments is premature ejaculation surgery.
Read on to find out the surgery options for PE, the risks and the alternative treatments to consider.
Reasons for Getting Premature Ejaculation Surgery
There are many reasons why you might consider premature ejaculation surgery.
Premature ejaculation — also known as early ejaculation or rapid ejaculation — can lead to stress, anxiety and low self-esteem. It may be distressing for both you and your partner, affect your quality of life and even cause relationship problems.
If it’s 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, more extreme treatments like surgery could really make a difference to your happiness — both in and out of the bedroom.
It can also depend on how severe your PE is. Some men may ejaculate less than a minute into sexual intercourse — or even before penetration — so surgery can really upgrade their sex lives.
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.
Surgery for Premature Ejaculation
When it comes to surgery for premature ejaculation, you’ve got a few options, and some are more invasive than others.
Here are the most common surgical treatments for PE.
Selective Dorsal Neurectomy (SDN)
Selective dorsal neurectomy (SDN) is a surgical treatment in which nerves in the penis are cut.
Bear with us. It’s less scary than it sounds.
There’s a nerve in your penis called the penile dorsal nerve. It helps to transmit sensations from the penis, and it 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 in a simple procedure. 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.
By the way, the average time before ejaculating is five to seven minutes, despite what you might hear.
The effect is permanent, with no meds 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.
ADM is made from the same material as human skin, so it’s compatible with the human body. It’s used in lip augmentation, breast reconstruction and other plastic surgeries.
The ADM condom works by reducing sensitivity in the skin of the penis, helping you last longer.
One study looked at 20 men who underwent the inner condom technique procedure. The treatment was found to increase the average time to ejaculation from about 40 seconds to about two and a half minutes.
The 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, which is blasting with cold, and radiofrequency, which uses high-frequency current, are both treatments for urinary tumors.
When targeted at the dorsal nerve, they can treat PE by reducing hypersensitivity in the penis and responses to sexual input signals.
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.
But there are some diminishing returns. After 90 days, men can last about three minutes and 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. But two of them spontaneously recovered and two recovered after taking PDE-5 inhibitors, a type of erectile dysfunction drug.
The other option, radiofrequency, has been shown to increase sex time before ejaculation from 18.5 seconds to two minutes and 20 seconds after three weeks. There were no erection problems, numbness or pain after the procedure.
Hyaluronic Acid (HA) Gel Glans Penis Augmentation
You might have heard of hyaluronic acid (HA) in skincare, but it has a role in the bedroom too.
HA is a natural chemical found in various human tissues, including the skin, eyes and connective tissue. As it’s found in the human body, there’s less chance than there is from some other treatments that you’ll have a bad reaction to it.
When injected into the penis, HA can increase the volume and circumference of the penis, acting as a bulking agent. And no, that’s not just to make you look bigger — HA under the skin blocks signals to the dorsal nerve so you can last longer.
A 2019 study looked at 20 men who were given 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. Another win? No adverse effects.
Combined treatments might be even more effective though. 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. 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 of the trial groups.
Risks of Surgical Treatments for Premature Ejaculation
As with all types of surgery, there are risks of PE surgical procedures. 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.
There are other problems you need to know about.
A selective dorsal neurectomy is invasive and it isn’t a sure-fire fix, as PE can come 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 contaminations in the infections, as well as tissue death from restricted blood flow caused by poorly delivered injections.
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Alternatives to Premature Ejaculation Surgery
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:
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
There are no medications 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:
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. You might experience some mild side effects, but these may be more tolerable than full-on surgery, depending on your PE.
You can learn more about one popular PE drug in our guide on 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 option of surgery.
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 blow, 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. When it’s time for round two, you may find you last longer.
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. Yep, we know this one’s tricky. But having an open and honest chat with your partner about sexual problems can take some of the stress off and reduce any lingering performance anxiety that might get in the way of a good experience. You can also brainstorm 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. Save this one for after sex. 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.
Knowing If Premature Ejaculation Surgery Is Right for You
No one wants to finish early during sex. But when you finish before things have even really started, 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, we can connect you with premature ejaculation treatments online, so you can avoid awkward trips to the doctor’s office.
Speak with a licensed healthcare provider and you’ll be recommended the best course of action to help you stay in the action for longer.