Premature Ejaculation Surgery: Selective Dorsal Neurectomy
Premature ejaculation is the most common sexual dysfunction in young men. It affects not only the man’s own satisfaction but also that of his partner. In patients who do not benefit from drug treatment, behavioural therapy and local anaesthetic creams — particularly where premature ejaculation is caused by excessive sensitivity at the head of the penis — selective dorsal neurectomy comes into consideration as a surgical option.
What Is Selective Dorsal Neurectomy?
Selective dorsal neurectomy (SDN) is a microsurgical procedure in which some of the dorsal nerves of the penis are selectively divided in order to reduce excessive nerve sensitivity at the head of the penis. One of the important causes of premature ejaculation is that the glans is stimulated immediately by even mild contact, so that the ejaculation reflex is triggered early. By reducing this sense of over-stimulation, ejaculation time can be prolonged and intercourse becomes more controlled.
How Is the Operation Performed?
SDN is generally carried out under local, spinal or general anaesthesia. During the procedure the dorsal nerves over the penis are first identified carefully and the branches carrying the most intense sensitivity are determined. Only those nerve fibres considered necessary are then divided carefully under the microscope. Because not all nerves but only the parts responsible for excessive sensitivity are divided, sexual pleasure is largely preserved. The patient is usually discharged the same day and can return to normal sexual life within a few weeks.
Who Is Selective Dorsal Neurectomy Suitable For?
Selective dorsal neurectomy may be recommended in the following situations:
- Patients who do not respond to medication, topical creams or other treatments
- Men with excessive sensitivity at the head of the penis
- Cases where premature ejaculation seriously affects quality of sexual life
- Those seeking a lasting, long-term solution
Every patient must undergo a comprehensive assessment before surgery. The level of nerve sensitivity of the penis is evaluated beforehand and it is determined whether the person is suitable for the procedure. As with any surgical procedure, SDN carries certain risks, so the decision should be made carefully together with the physician.
Neurectomy or Nerve Cooling (Cryoablation)?
There are two principal procedures that reduce glans sensitivity: neurectomy (surgical division of the nerve) and selective dorsal cryoablation (suppression of the nerve by freezing). In neurectomy the effect is closer to permanent, while cryoablation is less invasive but its effect may partially decrease over time. These surgical options are considered when medical treatments such as drugs and sprays have not produced a response. Which method is appropriate is determined by examination and by the individual’s expectations.
Key points
- SDN is a microsurgical procedure used in premature ejaculation due to glans hypersensitivity.
- Only selected (over-sensitive) branches of the dorsal nerve are divided; sexual pleasure is largely preserved.
- Local, spinal or general anaesthesia; usually same-day discharge, normal life within a few weeks.
- Considered in patients not responding to drugs, creams and behavioural treatment.
- The effect is close to permanent; it may decrease partially with nerve regeneration.
- Unlike cryoablation, the procedure cannot be reversed.
- Cryoablation is a less invasive alternative; the choice is individual.
Frequently Asked Questions About Selective Dorsal Neurectomy
Is the effect of selective dorsal neurectomy permanent?
Because it is based on dividing nerve branches, the effect is generally long lasting and close to permanent. Nevertheless, because of partial nerve regeneration, sensitivity may return to some degree over time in some patients.
Is there loss of sensation or orgasm afterwards?
Not all nerves are divided, only the selected dorsal nerve branches that cause excessive sensitivity. Sexual pleasure and orgasm are therefore largely preserved; the aim is only to reduce excessive stimulation.
Which is better, neurectomy or nerve cooling?
In neurectomy the nerve is cut and the effect is closer to permanent; in cryoablation the nerve is suppressed by freezing, which is less invasive but the effect may decrease over time. Which method is appropriate is determined by examination.
How long does the operation take and what is recovery like?
The procedure is performed microsurgically and usually takes a short time. The patient is generally discharged the same day and returns to normal sexual life within a few weeks.
How much does the surgery cost?
Cost is determined individually according to the patient’s condition and the clinical assessment, and under Turkish healthcare regulations fixed prices cannot be published. For an individual assessment you may contact the clinic.
What are the risks of neurectomy?
Temporary change in sensation, swelling or bruising may occur; rarely, sensation may be reduced more than intended. In experienced hands and with correct patient selection the risks are low. Unlike cryoablation, the procedure is not reversible.
Who is it not suitable for?
It may not be appropriate on its own in acquired premature ejaculation, in predominantly psychological premature ejaculation and in men with significant erectile dysfunction. Suitability is determined by detailed examination.
Which option suits you in premature ejaculation — neurectomy, nerve cooling or medical treatment — is 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. (Related study 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.
- Tang QL, Song T, Han YF, et al. The application of intraoperative neurophysiological monitoring in selective dorsal neurotomy for primary premature ejaculation: a prospective single-center study. Asian J Androl. 2023;25(1):137–142.
This content is for general information only and does not replace examination by a specialist. Every surgical procedure carries its own risks; suitability and possible outcomes vary between individuals. For diagnosis and treatment, please consult a specialist physician.