Prof. Dr. Volkan İzol Explains – A Comprehensive Approach to One of the Most Important Issues in Modern Men’s Sexual Health

Premature ejaculation is one of the most common sexual health problems in men and one that most significantly impacts their sex lives. It places a heavy burden not only physically but also psychologically, socially, and on their relationships. When my patients come to the clinic, I can often clearly see the disappointment on their faces and sense that feeling of “Doctor, I’ve lost control.”

In fact, premature ejaculation is not a condition to be ashamed of.

On the contrary, it is the most common male sexual health issue in the world. According to recent studies:

➡ Nearly 30% of men worldwide

➡ Nearly 40% of men in Turkey

At some point in his life, he experiences premature ejaculation.

In this article, I will discuss all the details you want to know about premature ejaculation, the most modern treatment options, methods that are just beginning to be used in Turkey—such as the penile sensometer—and advanced solutions like nerve freezing (cryoablative technique), all based entirely on my clinical experience.

This post may well be the most comprehensive and up-to-date blog post ever written in Turkey.

The medical definition is as follows:

It is the inability of a man to control his ejaculation reflex and his involuntary ejaculation shortly after sexual intercourse begins (usually within 1 minute).

However, modern medicine no longer bases diagnoses solely on duration but also on the following criteria:

•Loss of control

•Partner's dissatisfaction

•A man's sense of being out of control

•Sexual anxiety and loss of self-confidence

•Problems arising in a relationship

In other words, the “sense of control” is the key factor.

Premature ejaculation is divided into two main categories:

From the very moment a man begins his sexual life, he cannot control his ejaculation.

It may have genetic or neurological causes.

If a man who was previously healthy has been losing control in recent years, there may be an underlying medical condition:

•Erectile dysfunction

•Thyroid disorder

•Prostatitis

•Anxiety disorder

•Hormonal issues

•Psychological stress

•Vascular problems

For this reason, not all cases of premature ejaculation are the same; the evaluation is tailored to the individual.

Premature ejaculation is not caused by a single factor.

Below you will find the mechanisms we encounter most frequently:

Excessive sensitivity of the nerve endings in the penis is the primary cause of premature ejaculation.

This sensitivity may be innate or may develop over time.

Men who experience erectile dysfunction often resort to “finishing as quickly as possible” to avoid losing their erection.

This also triggers premature ejaculation.

The ejaculation reflex depends on serotonin levels in the brain.

If serotonin levels are low → ejaculation occurs quickly.

If serotonin levels are normalized → a delay is achieved.

Many men:

•A previous unsuccessful experience

•Compatibility issues with a partner

•Loss of self-confidence

This may lead to premature ejaculation.

•Low testosterone

•Thyroid disorders

•Prostatitis

•Vitamin deficiencies

It can trigger premature ejaculation.

The prostate gland is an organ surrounded by highly sensitive nerves.

As inflammation increases, ejaculatory control is impaired.

Men who have engaged in rapid masturbation for years and rush through sexual activity may develop psychological and reflex-based premature ejaculation.

At the outpatient clinic, I conduct an evaluation for premature ejaculation in four stages:

✔ 1) Detailed Story

Duration, triggering situation, nature of the relationship, partner compatibility.

✔ 2) Physical Examination

Examination of the penis, testicles, and prostate.

✔ 3) Blood Tests

•Testosterone

•Thyroid (TSH)

•Prolactin

•Vitamin D

•Blood sugar, lipid profile

✔ 4) Penile Sensometer

This device measures nerve sensitivity at the tip of the penis.

It is the most modern method for diagnosing premature ejaculation.

If nerve sensitivity is excessive → cryoablation or neuromodulation treatments are used.

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👉 Treatment for premature ejaculation is tailored to each individual.

There is no single magic cure.

In some patients:

•Nervous sensitivity is predominant

•Some people have low serotonin levels

•Some of them have prostatitis

•Psychological pressure in some cases

•In some cases, it is accompanied by erectile dysfunction

For this reason, treatment should always be a personalized combination.

Below, I explain all modern treatments one by one, based on my clinical experience.

✔ Stop–Start Technique

It increases arousal control.

✔ Squeezing Technique

If done correctly, it can be beneficial.

✔ Kegel (Pelvic Floor) Exercises

As pelvic muscle strength increases, ejaculatory control improves.

✔ Breathing and relaxation techniques

It reduces performance anxiety.

There are many “delay sprays” on the market, but not all of them are high-quality.

At the clinic, I recommend medications containing lidocaine and prilocaine.

The impact of these:

➡ It slightly numbs the nerve endings

➡ Reduces hypersensitivity upon contact

➡ Significantly prolongs the duration of sexual intercourse

However, if not used in the correct dose, it can significantly reduce sensitivity.

It is one of the most effective treatments in modern medicine.

✔ Dapoxetine

It is a fast-acting, effective serotonin-boosting medication.

Take it 2–3 hours before intercourse.

✔ SSRI medications

It provides significant latency in everyday use.

✔ Low-dose tramadol

It can be used in specially selected cases.

These medications are among the most scientifically proven treatments.

If there is an inflammation of the prostate:

•Antibiotic

•Anti-inflammatory

•Herbal supplements

•Hot sitz baths

It can significantly reduce premature ejaculation.

If there is an erection problem, premature ejaculation will not resolve on its own.

In this case, treatment is as follows:

➡ Phosphodiesterase inhibitors (Cialis, Viagra)

➡ ESWT (shock wave)

➡ PRP

➡ Exosome/Stem Cell Supplements

As erectile function improves, control over ejaculation also improves.

This device objectively measures nerve sensitivity at the tip of the penis.

What is a penile sensometer used for?

•Accurately identifies nerve hypersensitivity

•Indicates which patients will benefit from the medication

•Identifies suitable candidates for nerve freezing

•Tailors the treatment plan

This method is a revolutionary tool in the treatment of premature ejaculation.

– Today’s Most Innovative Solution**

This technique, which has become widespread in the global literature in recent years and which I also use in Turkey, reduces sensitivity by temporarily numbing hypersensitive nerve endings.

How do you do it?

•Local anesthesia is administered at the base of the penis

•A special cryo device is used to briefly freeze the nerve endings at around -70°C

•The process takes 15–20 minutes

•It is absolutely painless

•It is possible to go about your normal life on the same day

Effect:

➡ Nerve sensitivity decreases

➡ Ejaculation control improves significantly

➡ The effect lasts 6–12 months

This treatment yields excellent results, particularly in patients in whom hypersensitivity has been detected using a penile sensometer.

These are injection techniques that slow down nerve transmission.

It results in significant improvement in most patients, lasting 3–6 months.

If premature ejaculation is caused by anxiety and stress, couples therapy may be necessary.

In my own clinical practice, I outline a roadmap for the patient as follows:

✔ 1) Diagnosis → Penile Sensometer + Blood tests

✔ 2) Identifying the triggering cause

✔ 3) Personalized treatment plan

•If nerve sensitivity is predominant → nerve block

•If serotonin levels are low → medication

•If you have prostatitis → prostate treatment

•If you have erectile dysfunction → ED treatment

•If there is a psychological cause → therapy + education

•If a short-term solution is needed → spray/cream

✔ 4) Follow-up in 4–6 weeks

✔ 5) Combination therapy, if necessary

This systematic approach achieves an 80–95% success rate in the majority of patients.

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Yes, with the right treatment, it usually resolves.

The rate of permanent remission is high.

However:

•The underlying cause must be correctly identified

•Treatment should be tailored to the patient

•A combination of methods should be used instead of a single method

If managed properly, long-term success is possible.

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Since premature ejaculation is unique to each individual,

There is no “single miracle solution.”

However, modern medicine identifies these three methods as the most lasting solutions:

✔ 1) Nerve Cryotherapy (Cryo)

✔ 2) Serotonin-based medications

✔ 3) Resolving erectile dysfunction

These three methods produce lasting results in most patients.

⸻

•In young men

•In people with an overly sensitive nervous system

•In men with erectile dysfunction

•In people with prostatitis

•In people who have been under stress for a long time

•Among those who became accustomed to rapid masturbation during adolescence

•In people with thyroid disorders

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•Loss of self-confidence

•It causes problems in the relationship

•A loss of sexual desire may develop

•The severity of premature ejaculation may increase

• Depression and anxiety may be triggered

Premature ejaculation does not resolve on its own over time; in most cases, it gets worse.

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❓ Can premature ejaculation be completely cured?

Yes.

❓ Does nerve freezing hurt?

No, it's completely painless.

❓ How long before intercourse should the medication be taken?

Usually 2–3 hours ago.

❓ Is using a spray harmful?

It is safe when taken in the correct dose.

❓ Does the same treatment work for every man?

No. Treatment is tailored to the individual.

❓ What is the best treatment?

It depends on the underlying cause.

Premature ejaculation is a condition that significantly affects men’s quality of life but can be controlled in a very high percentage of cases with the right treatment. In modern medicine, both diagnostic and treatment options have greatly improved. Success rates have approached 90% thanks to techniques such as the penile sensometer, nerve freezing, neuromodulation, combination therapies, and psychological support.

I always tell my patients:

“Premature ejaculation is not inevitable. With the right diagnosis and the right treatment, it can be largely resolved.”