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?
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.
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.
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.
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.
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.
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, significant erectile dysfunction, penile deformity, active urinary tract infection 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; in cryoablation the nerve is not cut but suppressed by controlled cooling, and the nerve sheath is preserved. Which method is appropriate is determined by 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.
Scientific References
- 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)
- 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(11):1383–1389.
- 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.
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.