Nerve Resection (Selective Dorsal Penile Neurectomy) in the Treatment of Premature Ejaculation
Nerve Resection (Selective Dorsal Penile Neurectomy) in the Treatment of Premature Ejaculation
What Is a Nerve Resection (Selective Dorsal Penile Neurectomy)?
Selective dorsal penile neurotomy is a surgical procedure performed to reduce hypersensitivity of the glans penis as part of the treatment for premature ejaculation.
In this method:
The nerve that transmits sensation from the head of the penis
Selected branches of the dorsal penile nerve
Under a microscope or magnifying glass
It is cut in a controlled and limited manner
Purpose
👉 It’s not about completely eliminating sensation in the penis,
👉 but about bringing excessive arousal back within physiological limits.
The Mechanism of Action of Nerve Blockade
The ejaculation reflex begins when sensory stimuli from the penis are transmitted to centers in the spinal cord and brain.
In some men with premature ejaculation:
Sensitivity in the glans penis is greater than normal
The ejaculation reflex is triggered by a very low stimulus
With selective neurectomy:
The signal pathway is partially reduced
The reflex threshold is raised
The time to ejaculation increases
The sense of control increases
Who Is It For?
Nerve-cutting surgery is not suitable for every patient with premature ejaculation.
Suitable Patient Profile
Primary (lifelong) premature ejaculation
Noticeable sensitivity of the glans penis
Positive response to local anesthetic tests (lidocaine test)
Patients who have not responded to medication or other conservative treatments
Patients with realistic expectations and who are well-informed
Patients Who Are Not Suitable
Situations in which psychological factors are predominant
Secondary premature ejaculation (prostatitis, etc.)
Patients with erectile dysfunction
Unrealistic expectations
People who expect a “definitive solution”
Preoperative Evaluation
The decision to perform a nerve resection should be made after a detailed evaluation.
In the evaluation:
Detailed sexual history
IELT (Intravaginal Ejaculation Latency Time) measurement
Sensory mapping of the penis
Local Anesthetic Test
Psychosexual evaluation, if necessary
is done.
How Is a Nerve Resection Performed?
Surgical Technique
The procedure is usually performed under local or spinal anesthesia
A small incision is made on the dorsal surface of the penis
The dorsal nerve branches are identified under a microscope
Only selected branches are cut
Cutting all the nerves is absolutely not done
Surgery duration:
👉 Approximately 30–60 minutes
Hospital admission:
👉 It's usually not necessary
Postoperative Process
Same-day discharge
There may be mild pain and swelling
A 7–10-day period of sexual abstinence is recommended
Return to a normal sex life within 3–4 weeks
Event and Success Rates
The results reported in the literature vary:
There are studies reporting a 2–4-fold increase in IELT duration
Patient satisfaction ranges from 50% to 70%
There is no consensus on the long-term outcomes
📌 For this reason, nerve resection should be considered only in selected patients and as a last-resort treatment.
Possible Risks and Complications
Nerve resection surgery is an irreversible procedure.
Potential risks:
Permanent loss of sensation
Drowsiness
Decrease in sexual pleasure
A loss of satisfaction
Rare cases of erectile dysfunction
Failure to realize the expected benefit
For this reason, the patient must be provided with detailed information.
Ethical and Scientific Debates
In international guidelines:
Nerve-cutting surgery is not a routinely recommended procedure
It is recommended that this procedure be performed at experienced centers and on selected patients
Nowadays, less invasive methods (nerve freezing, fillers, etc.) have come to the forefront.
Frequently Asked Questions
Is nerve resection permanent?
Yes. Resected nerves do not return to their original state.
Will sensation be completely lost?
The goal is not complete loss of sensation; however, there may be a noticeable decrease in some patients.
Does it cause erectile dysfunction?
The nerves that directly cause an erection are not cut; however, there may be indirect effects.
Does it work for everyone?
No. Patient selection is the most critical factor.
Conclusion and Evaluation
Nerve resection (selective dorsal penile neurotomy) is an advanced and irreversible surgical option for the treatment of premature ejaculation that should be performed by experienced surgeons on carefully selected patients.
In the modern approach:
First, medical and minimally invasive methods
Surgery as a last resort
This should be considered.
It is essential to develop a personalized treatment plan for each patient.