Premature ejaculation (PE) is a common male sexual dysfunction characterized by ejaculation occurring sooner than desired during sexual activity. This condition can significantly impact quality of life and intimate relationships. While various treatment modalities exist, including behavioral therapies and medications, surgical interventions are sometimes explored for specific cases when other less invasive treatments have not provided sufficient improvement.
Surgical Approaches
One surgical intervention for premature ejaculation is Selective Dorsal Neurotomy (SDN), a procedure that aims to reduce penile sensitivity. During SDN, surgeons identify and precisely cut a selection of the sensory nerve branches in the dorsal area of the penis. The underlying principle is that by decreasing the nerve signals transmitted from the penis to the brain, the ejaculatory reflex is delayed, allowing for longer intercourse duration. This invasive procedure is typically performed under local or general anesthesia.
Another approach involves glans augmentation using hyaluronic acid (HA) injections. This minimally invasive procedure entails injecting biocompatible fillers, such as HA gel, into the subcutaneous layers of the glans penis. The injected material creates a cushioning barrier, which dampens the tactile stimuli reaching the nerve receptors in the glans. This reduction in tactile sensitivity helps to delay the ejaculatory reflex. The augmentation also increases glans volume, potentially further reducing sensitivity and increasing intravaginal ejaculatory latency time (IELT).
Effectiveness and Patient Suitability
Selective Dorsal Neurotomy (SDN) has shown effectiveness in improving ejaculatory control for many individuals. Studies indicate that between 60% and 80% of patients report a significant improvement in their ability to control ejaculation after the procedure. Patients often experience a reduction in penile sensitivity, which can contribute to longer-lasting intercourse. The increase in intravaginal ejaculatory latency time (IELT) and patient satisfaction tends to be long-lasting for many individuals.
Glans augmentation with hyaluronic acid (HA) injections has also demonstrated an ability to increase IELT. Research suggests that HA injections can increase IELT by approximately 2.43 to 4.46 times. This improvement can persist for a substantial period, with some studies reporting effects lasting up to five years. The efficacy is attributed to the reduced sensation threshold of the glans penis.
These surgical options are generally considered for specific patient profiles, primarily individuals experiencing severe, lifelong premature ejaculation that has not responded to less invasive therapies. Careful patient selection is important, involving a thorough evaluation by a urologist to determine suitability. This assessment helps ensure that the potential benefits outweigh the inherent risks associated with surgical intervention.
Potential Risks and Complications
Surgical interventions for premature ejaculation carry various potential risks and complications that individuals should consider. For Selective Dorsal Neurotomy (SDN), a primary concern is the potential for permanent changes in penile sensation. This can manifest as reduced sensation or even permanent numbness in parts of the penis. Other reported complications include scarring at the surgical site, infection, and, in rare instances, erectile dysfunction.
Glans augmentation with hyaluronic acid injections also presents a range of potential side effects. Common temporary issues include swelling, redness, and bruising at the injection site, which typically resolve within a few days to two weeks. More persistent or significant complications can include the formation of subcutaneous nodules or lumps, which may be felt or seen. There is also a risk of filler migration from the original injection site, potentially leading to asymmetry.
Although rare, infection at the injection site is a possibility, and allergic reactions to hyaluronic acid, while uncommon, can occur. Individuals considering these procedures should have a clear understanding of these potential outcomes, particularly the irreversible nature of nerve alterations in SDN.