Premature ejaculation is one of the most common sexual dysfunctions in men and should be evaluated not only in terms of the short duration of sexual intercourse but also in terms of loss of ejaculatory control, decreased self-confidence, and partner dissatisfaction. Today, there are many different methods for treating premature ejaculation. One of these methods is commonly known as “nerve cutting” and is medically referred to as selective dorsal penile neurotomy.
In this article, I aim to provide clear, realistic, and scientific answers to the most frequently asked questions about nerve-cutting surgery for the treatment of premature ejaculation.
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What Is Premature Ejaculation?
Premature ejaculation is when a person ejaculates involuntarily and uncontrollably, either before sexual intercourse begins or shortly after it begins. Clinically, ejaculation that occurs within the first minute after vaginal penetration is most often defined as premature ejaculation.
However, time alone is not enough. What really matters is:
•Loss of control over ejaculation
•A feeling of discomfort in the individual and their partner
•The problem is that it persists
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What Causes Premature Ejaculation?
Premature ejaculation is not caused by a single factor. The most common causes are as follows:
•Excessive sensitivity of the glans
•Increased nerve conduction velocity
•Performance anxiety and stress
•Experiencing premature ejaculation during one’s first sexual encounters
•Urological conditions such as prostatitis
Sensitivity of the glans penis, in particular, is the primary cause of premature ejaculation in some men. The goal here is to regulate nerve transmission.
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What Are the Treatment Options for Premature Ejaculation?
In modern urology, treatment for premature ejaculation is planned in a stepwise manner:
•Behavioral techniques
•Local anesthetic creams
•Oral medications (SSRI class)
•Psychosexual therapy
•Minimally invasive procedures
•Surgical methods (nerve resection)
Nerve-cutting surgery is not the first-line treatment for premature ejaculation. It is generally considered for patients who have not benefited from other methods.
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What Is a Nerve Resection (Selective Dorsal Penile Neurectomy)?
Nerve-cutting surgery is a procedure in which certain branches of the dorsal penile nerve—which carries sensation to the head of the penis—are cut in a controlled and limited manner.
Purpose:
•It is not a complete loss of sensation in the penis
•Reducing hypersensitivity
•It is the delay of the ejaculation reflex
For this reason, the procedure is performed selectively; not all nerves are cut.
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How Does Nerve Cutting Delay Premature Ejaculation?
The ejaculation reflex occurs when sensory stimuli from the head of the penis are transmitted to the brain’s centers. In some men, this transmission:
•It's very fast
•Triggered by a very low alert
With selective dorsal penile neurotomy:
•Excessive nerve impulse transmission is reduced
•The ejaculation threshold increases
•Ejaculation may take longer
•The sense of control may increase
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Who Is a Good Candidate for Nerve Resection Surgery?
Nerve-cutting surgery is not suitable for every patient with premature ejaculation.
Suitable Patient Profile
•People with lifelong (primary) premature ejaculation
•Patients with marked sensitivity of the glans penis
•Those who benefit from local anesthetic tests
•Those who have not seen results from medication and other treatments
•Patients who are aware that this is an irreversible procedure
Patients Who Are Not Suitable
•Those in whom psychological factors are predominant
•Secondary premature ejaculation
•People with erectile dysfunction
•Those who are hoping for a “definitive solution”
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How Is a Nerve Resection Performed?
•It is performed under local or spinal anesthesia
•A small incision is made on the dorsal side of the penis
•The dorsal nerve branches are identified under a microscope
•Only selected branches are cut
•The processing time is usually 30–60 minutes
Most patients are discharged the same day.
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What Is the Postoperative Process Like?
•There may be mild pain and swelling in the first few days
•An average of 7–10 days of sexual abstinence is recommended
•It is possible to resume sexual activity within 3–4 weeks
Results may vary from person to person.
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Are There Any Risks Associated with Nerve Resection Surgery?
Yes. Nerve resection surgery is an irreversible procedure.
Potential risks:
•Permanent loss of sensation at the tip of the penis
•A feeling of numbness
•Decreased sexual pleasure
•Failure to realize the expected benefit
For this reason, the patient must be provided with detailed information.
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Why Is It Less Popular These Days?
In recent years, regarding the treatment of premature ejaculation:
•Nerve freezing
•Penile head augmentation
•Combined and reversible methods
are more commonly used. When these methods fail, surgical options are considered.
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Prof. Dr. Volkan İzol’s Clinical Approach
Prof. Dr. Volkan İzol evaluates each patient individually when treating premature ejaculation. When developing a treatment plan:
•The root cause of the problem is analyzed in detail
•Treatment begins with the least invasive methods
•Surgery is considered only for appropriate patients and as a last resort
The goal is to provide the patient with the safest, most effective, and most appropriate treatment.
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Conclusion
Nerve resection (selective dorsal penile neurotomy) is a method that can be beneficial in the treatment of premature ejaculation when performed on the right patient with the appropriate indication. However, it is not suitable for everyone and should not be viewed as a miracle cure.
The most important aspect of treating premature ejaculation is a scientific, ethical, and personalized approach.