Comprehensive Guide to Treating Premature Ejaculation

What is Ejaculation and Premature Ejaculation?

Ejaculation is the process of releasing semen from the penis, involving the coordinated work of multiple systems:

• Brain – The control center that processes sexual stimuli (Marson L et al., 1993)
  
• Spinal Cord – Relays signals and can trigger ejaculation directly (Truitt WA & Coolen LM, 2002)
  
• Penile Nerves – Sensory receptors for touch and pressure (Giuliano F & Clement P, 2005)
  

Premature Ejaculation (PE) is when ejaculation occurs earlier than desired, affecting sexual satisfaction for you or your partner.

• Average men: 5–6 minutes before ejaculation
  
• Men with PE: Ejaculation within 1–2 minutes or faster (BJU International; Journal of Sexual Medicine)
  

Types of Premature Ejaculation

1. Lifelong Premature Ejaculation – Present from the first sexual experience, often linked to genetic or neurological factors
   
2. Acquired Premature Ejaculation – Develops later in life, can be caused by illness, hormones, stress, or injury
   

Treatment Options (from least to most invasive)

1. SSRIs (Selective Serotonin Reuptake Inhibitors)

• Role: Delay ejaculation by slowing brain signaling
  
• Best for: Men whose PE is mainly due to brain-level or anxiety factors
  
• Pros: Easy to use, quick effect
  
• Cons: Requires continuous use, possible side effects like drowsiness, nausea
  

2. Behavioral Control Techniques

• Stop–Start technique
  
• Squeeze technique
  
• Deep breathing to reduce arousal
  
• Psychological therapy to reduce performance anxiety
  

Pros: Safe, no drug side effects
Cons: Requires time and consistency

3. Numbing Creams or Special Condoms

• Topical anesthetics (lidocaine/prilocaine) – temporarily reduce sensitivity
  
• Thicker condoms – reduce friction
  

Pros: On-demand use, immediate results
Cons: Can reduce sensation too much for you or your partner

4. PGA Filler Desensitization

Injecting filler (e.g., Hyaluronic Acid – HA) around the glans penis to create a “cushion” between the skin and nerve endings, reducing direct stimulation.

• Results: Prolonged ejaculation time, lasts 6–12 months
  
• Pros: Non-surgical, quick recovery
  
• Cons: Temporary, requires repeat injections
  

Selective Dorsal Nerve Neurectomy (SDN)

A surgery that selectively cuts certain branches of the dorsal nerve to reduce hypersensitivity.

Conventional SDN (C-SDN)

Standard surgery that cuts superficial branches of the dorsal nerve at the penile base to reduce sensitivity while preserving primary sensation.

• Pros: Less complex, lower risk
  
• Cons: Less sensitivity reduction than advanced techniques
  
• Best for: Men wanting moderate, permanent reduction with sensation preservation
  

C-SDN + PGA Filler Desensitization

Combining standard surgery with filler injection around the glans.

• Pros: Targets both nerve conduction (C-SDN) and direct friction reduction (filler)
  
• Results: Greater and faster improvement than either method alone
  
• Best for: Men wanting stronger results without deep surgery
  

Advanced SDN (SDNplus)

A deeper nerve-cutting technique, often possible in men undergoing Penile Lengthening surgery.

• Can access deeper nerve branches for significantly greater sensitivity reduction
  
• Best for men wanting maximum reduction and undergoing penile lengthening
  
• Requires a specialist surgeon
  

Penile Lengthening with SDNplus

If undergoing penile lengthening, SDNplus can be performed in the same surgery.

• One operation, one anesthesia
  
• Access to deeper dorsal nerve branches for greater sensitivity reduction
  
• Results in both length increase and PE improvement
  

Mix & Match Treatment Approach

You can mix and match treatments to suit your needs. Four main elements to choose from:

1. SSRIs – Brain-level solution
   
2. PGA-D Filler – Peripheral sensitivity reduction
   
3. Behavioral training – Skill-based control improvement
   
4. Surgery – C-SDN or Penile Lengthening + SDNplus
   

Example Combinations

• SSRIs + Behavioral training → Brain + skill improvement, ideal as a first step
  
• PGA-D Filler + Behavioral training → Reduced sensitivity + improved control, no surgery
  
• C-SDN + PGA-D Filler → Permanent nerve reduction + immediate friction reduction
  
• Penile Lengthening + SDNplus + SSRIs → Increased length + maximum sensitivity reduction + brain-level control
  

Conclusion

There is no one-size-fits-all cure for PE.

• If avoiding surgery → Start with medication, behavioral techniques, or filler
  
• If wanting permanent results → Consider C-SDN or SDNplus
  
• If having penile lengthening → Consider combining with SDNplus
  
• Mix & Match often produces better results than any single method
  

A specialist consultation is essential to choose the safest, most effective plan for your needs.