Selective Dorsal Cryoablation (Nerve Cooling) for Premature Ejaculation
Selective dorsal cryoablation (SDC) is a modern andrological procedure based on temporarily suppressing selected branches of the dorsal penile nerve by controlled cooling, in order to reduce excessive sensitivity at the head of the penis in premature ejaculation. On this page I explain what the procedure is, who it suits, how it is performed, and the real results of our own scientific study, in honest terms.
- What is selective dorsal cryoablation?
- Who is it suitable for, and who is it not?
- How is the procedure performed?
- Does it work? Our 24-month follow-up results
- Side effects and safety
- Is the effect permanent? An honest assessment
- Cryoablation or neurectomy?
- Comparison of all treatment options
- For patients travelling from abroad
- Frequently asked questions
What Is Selective Dorsal Cryoablation?
One of the important causes of premature ejaculation is penile hypersensitivity and an over-excitable ejaculation reflex. SDC reduces sensitivity by controlled freezing of selected branches of the dorsal penile nerve at temperatures reaching approximately −78°C; this is called desensitisation. Its difference from neurectomy, in which the nerve is cut, is that the nerve is not divided — it is only suppressed by freezing. Because the nerve sheath is preserved, partial regeneration may occur over time.
How is premature ejaculation defined? The International Society for Sexual Medicine (ISSM) describes two types:
Lifelong (primary): From the beginning of sexual life, ejaculation occurring within about one minute of vaginal penetration in nearly every episode of intercourse.
Acquired: In a man who previously ejaculated normally, a clinically significant reduction in latency time, typically to under three minutes.
SDC is primarily considered in the lifelong type, in patients refractory to medication.
Who Is Selective Dorsal Cryoablation Suitable For?
SDC is generally considered in patients with the following characteristics:
- A diagnosis of lifelong (primary) premature ejaculation according to ISSM criteria,
- Ejaculation time (IELT) below 2 minutes in most intercourse,
- No response to, or intolerance of, first-line treatments such as medication and sprays,
- Age between 18 and 65 with no significant erectile dysfunction.
Acquired premature ejaculation, penile deformity, active infection and certain neurological or psychiatric conditions may limit suitability. The final decision is made after a detailed examination.
Who Is It Not Suitable For?
This section is omitted by most sources, yet it matters at least as much as the rest when making a decision:
- Acquired premature ejaculation
- Premature ejaculation of primarily psychological origin — where anxiety, relationship difficulty or performance concern predominates, therapy takes priority
- Situational premature ejaculation (occurring only with a particular partner or in particular circumstances)
- Significant erectile dysfunction — this must be addressed first
- Penile deformity
- Active urinary tract infection or local skin infection
- Bleeding disorders
- Certain neurological or psychiatric conditions
- Patients expecting complete loss of sensation; that is not the aim of this procedure
How Is the Procedure Performed?
The procedure is performed under local anaesthesia. Under ultrasound guidance, a fine cryoprobe is placed at the root of the penis, close to the dorsal neurovascular structure. The target nerve is confirmed by neurostimulation (tingling at the head of the penis is taken as the sensory threshold; motor function is preserved). A two-stage Freeze–Thaw–Freeze protocol is then applied: the nerve tissue is frozen at approximately −78°C for about 2 minutes, thawed for 1 minute, then frozen a second time for the same duration and at the same temperature. The procedure is performed bilaterally for a balanced result.
Does Nerve Cooling Work? (Scientific Results)
We evaluated the medium-term outcomes of this method in a study conducted by our clinic with 24 months of follow-up (Güleser & Eren, Rev Int Androl, 2026). The real results obtained in 47 patients with medically refractory lifelong premature ejaculation were as follows:
- Mean ejaculation time (IELT) rose from 48.6 seconds before the procedure to 250 seconds at month 3 (approximately a fivefold increase).
- At month 12, 83% of patients met the predefined success criteria.
- The effect diminished partially over time; at month 24 the mean IELT was 169.5 seconds and the success rate 70.2%.
- PEDT (premature ejaculation diagnostic score) fell from 17.2 to 7.3 at month 3.
- Results were more favourable in non-smokers and in patients with a body mass index below 30.
These data indicate that SDC is a meaningful option particularly in patients who do not respond to medication, but that the effect can decrease over time.
What does the international literature say?
A systematic review and meta-analysis published in The Journal of Sexual Medicine in 2025 examined 7 studies with a total of 235 patients, reporting a mean increase of 147.5 seconds in ejaculation time, no meaningful change in erectile function, and an adverse event rate of 11.17%.[2]
The authors of that review specifically emphasise that follow-up periods in the existing studies are short and that research with longer follow-up is needed. Our clinic’s 24-month follow-up study was designed to address precisely that gap; it represents one of the longest reported follow-up periods for this procedure.
Side Effects and Safety
In our study, the side effects reported in the first month after the procedure were pain (8.5%), swelling (12.8%), redness (14.9%) and tingling or numbness (6.4%). All of these were mild and temporary and resolved spontaneously within a short time. No permanent or long-term side effect was observed. Nevertheless, as with any surgical or interventional procedure, risks must be assessed individually.
Is the Effect Permanent? An Honest Assessment
SDC is not a definitive, lifelong solution for every patient. Because of partial nerve regeneration and the adaptation mechanisms of the nervous system (neuroadaptation), the effect may decrease over time. Some patients may therefore need a repeat procedure or behavioural and medical support. In addition, in studies without a control group, factors such as the placebo effect and regression to the mean may influence the results. In short, when assessed with realistic expectations, SDC is a method that provides clear benefit in the short and medium term.
Cryoablation or Neurectomy?
There are two main nerve-directed approaches in premature ejaculation, and the difference between them determines whether the patient has a way back.
| Cryoablation (SDC) | Neurectomy (SDN) | |
|---|---|---|
| What happens to the nerve | Suppressed by freezing, not cut | Cut surgically |
| Reversibility | Yes — effect diminishes over time | No — permanent |
| Incision and sutures | Needle entry, no sutures | Surgical incision and sutures |
| Anaesthesia | Local | Local or general |
| Duration of effect | Medium term, repeatable | Permanent |
| Margin for error | Overtreatment resolves in time | Overtreatment cannot be undone |
Scroll the table horizontally.
The greatest advantage and the greatest disadvantage of cryoablation are the same thing. Being reversible gives a margin of safety to a patient who is not satisfied with the result; for the same reason the effect does not last a lifetime.
Comparison of All Treatment Options
There is no single correct treatment for premature ejaculation. The options are considered in a stepwise manner:
| Method | Application | Duration of effect | Advantage | Limitation |
|---|---|---|---|---|
| Behavioural therapy | Exercises and education | Variable | Drug-free, no side effects | Time-consuming, requires discipline |
| Medical treatment | Oral medication | 4-6 hours | Rapid effect, reversible | Taken before each intercourse, side effects possible |
| Topical delay spray | Spray or cream | 30-60 minutes | Easily accessible | Can transfer to partner, excessive numbness |
| Glans augmentation | HA filler injection | 12-18 months | Reversible, adds girth | Requires renewal |
| Cryoablation (SDC) | Nerve cooling | Medium term | No incision, nerve preserved, repeatable | Effect diminishes over time |
| Neurectomy (SDN) | Surgical nerve division | Permanent | Lasting result | Irreversible, surgical incision |
Scroll the table horizontally.
You can find all options and who each one suits together on the premature ejaculation treatment page.
For Patients Travelling from Abroad
SDC is performed under local anaesthesia and does not require hospital admission, which makes it practical for patients travelling to Istanbul. A preliminary assessment can be made remotely through medical history and any existing test results; the final decision is always made after in-person examination at the clinic in Bakırköy.
Because there is no incision and no sutures, the recovery period is short. A follow-up plan is agreed before you return home, with assessments scheduled at months 3, 12 and 24.
Key points
- SDC reduces sensitivity by controlled freezing (−78°C) of the dorsal penile nerve; the nerve is not cut.
- Performed under local anaesthesia with ultrasound guidance, bilaterally, using a Freeze–Thaw–Freeze protocol.
- In our own study: IELT 48.6→250 s (month 3), 83% success (month 12), 70.2% at month 24.
- Side effects mild and temporary (pain, swelling, redness, tingling); no permanent side effect observed.
- Sexual sensation and orgasm are preserved; complete loss of sensation is not the aim.
- The effect may decrease over time; realistic expectations and follow-up matter.
- Not suitable in erectile dysfunction, acquired PE and certain other conditions.
Frequently Asked Questions About Selective Dorsal Cryoablation
Does nerve cooling (SDC) work for premature ejaculation?
Yes. It increases ejaculation time significantly in patients refractory to drug treatment. In our own 24-month study, mean ejaculation time rose from 48.6 seconds to 250 seconds at month 3, and 83% of patients met the success criteria at month 12. The effect may diminish partially over time.
How long does the effect last and is it permanent?
It is effective in the medium term; however, because of partial nerve regeneration the effect may decrease over time. In our study the success rate was 83% at month 12 and fell to 70.2% at month 24. Permanence cannot be guaranteed; some patients may need a repeat procedure or additional treatment.
Is there loss of sensation in the penis afterwards?
The aim is to reduce excessive sensitivity; complete loss of sensation is not the goal. Sexual sensation and orgasm are preserved. In our study both sexual satisfaction and partner satisfaction increased.
What are the side effects?
In our clinic’s study the side effects reported in the first month were redness 14.9%, swelling 12.8%, pain 8.5% and tingling or numbness 6.4%. All were mild and temporary and resolved spontaneously. No permanent or long-term side effect was observed. The overall adverse event rate reported in the 2025 international meta-analysis is 11.17%.
Is the procedure painful, how long does it take and what is recovery like?
The procedure is performed under local anaesthesia and usually takes a short time. Recovery is rapid; mild swelling, redness or tingling may occur in the first days and these are temporary. Your individual course is clarified at examination.
How much does the procedure cost?
Cost is determined individually according to the patient’s condition, the method to be applied and the clinical assessment. Under Turkish healthcare regulations fixed prices cannot be published on a medical website. For current information and an individual assessment you may contact the clinic.
Who is it not suitable for?
It may not be suitable in acquired premature ejaculation, premature ejaculation of primarily psychological origin, situational premature ejaculation, significant erectile dysfunction, penile deformity, active urinary tract infection, bleeding disorders and certain neurological or psychiatric conditions. Suitability is determined by examination.
Will medication still be needed after the procedure?
In most patients the need for medication decreases; however, behavioural techniques or additional medical support may be helpful in some patients. Regular follow-up is important.
What is the difference between cryoablation and neurectomy?
In neurectomy the nerve is cut surgically and the effect is permanent but irreversible; in cryoablation the nerve is not cut but suppressed by controlled cooling, and the nerve sheath is preserved, so the effect is reversible. Which method is appropriate is determined by examination.
Can the procedure be repeated?
Yes. Because the nerve is anatomically preserved, the procedure can be repeated when the effect diminishes. The timing of a repeat procedure varies between patients and is decided at a follow-up examination.
Can international patients have this procedure in Istanbul?
Yes. A preliminary assessment can be made remotely through medical history and existing test results. Because the procedure is performed under local anaesthesia and does not require hospital admission, a short stay in Istanbul is usually sufficient. The final decision is made after in-person examination.
The method most suitable for you in premature ejaculation — medication, spray, nerve cooling or neurectomy — can only be determined by examination. Get in touch for an assessment or an appointment.
Appointment via WhatsAppScientific References
- [1] Güleser AS, Eren A. Medium-term outcomes of selective dorsal cryoablation in medically refractory lifelong premature ejaculation: a 24-month follow-up study. Rev Int Androl. 2026. (Study conducted by our clinic)
- [2] Culha MG, Erkoc M, Baran C, Ozcan L. Clinical efficacy and safety of selective dorsal neurectomy/cryoablation for treatment of premature ejaculation: systematic review and meta-analysis. J Sex Med. 2025;22(8):1383–1389.
- [3] Prologo JD, Snyder LL, Cherullo E, et al. Percutaneous CT-guided cryoablation of the dorsal penile nerve for treatment of symptomatic premature ejaculation. J Vasc Interv Radiol. 2013;24(2):214–219.
- [4] Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine’s guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med. 2014;11:1392–1422.
This content is for general information only and does not replace examination by a specialist. The success rates given are taken from the study conducted by our clinic; individual results vary according to the patient’s condition. For diagnosis and treatment, please consult a specialist physician.
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