Selective Dorsal Neurotomy (SDN) for Primary Premature Ejaculation: A Surgical Solution for Long-Lasting Control

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Premature ejaculation (PE) is one of the most common male sexual dysfunctions, affecting approximately 20%–30% of men globally. Defined by persistent or recurrent ejaculation within one minute of penetration, PE can significantly impact self-esteem, relationship satisfaction, and quality of life.

 

While various behavioral therapies and medications (SSRIs, topical anesthetics) can provide temporary relief, some men — particularly those with primary, lifelong PE — do not respond adequately to these conservative treatments. For these select cases, surgical intervention may be the key to achieving lasting control.

 

One such promising procedure is the Selective Dorsal Neurotomy (SDN) — also known as Selective Dorsal Neurectomy — a microsurgical procedure that targets the nerve pathways responsible for penile hypersensitivity.

 

 

 

What Is Selective Dorsal Neurotomy (SDN)?

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Selective Dorsal Neurotomy is a minimally invasive surgical procedure aimed at reducing penile sensitivity by partially severing the dorsal penile nerves — the nerves responsible for transmitting tactile sensation from the glans penis to the spinal cord.

 

By carefully identifying and transecting overactive or hypersensitive branches, SDN helps delay the ejaculation reflex in properly selected patients, offering long-term improvement without relying on daily medications or topical creams.

 

 

 

When Is SDN Recommended?

 

SDN is not for every patient with PE. It is a highly specialized procedure reserved for men who:

 

• Have primary (lifelong) PE, not acquired PE due to psychological or hormonal factors.

• Report ejaculation within 30–60 seconds of penetration consistently since first sexual experience.

• Have no erectile dysfunction, as SDN can worsen erection in some cases if done excessively.

• Show evidence of penile hypersensitivity, confirmed via:

   

  • Biothesiometry (penile sensitivity testing)

  • Response to local anesthetic cream

  • Diagnostic penile block tests

   

• Have failed or become resistant to conservative treatments such as SSRIs, behavioral therapy, topical anesthetics (lidocaine/prilocaine), or psychotherapy.

 

 

Anatomy Behind the Procedure

 

 

The dorsal nerve of the penis is a sensory branch of the pudendal nerve. It splits into multiple fine nerve branches, particularly on the dorsolateral sides of the penile shaft, and connects to sensory receptors in the glans penis.

 

These nerves are responsible for:

 

• Sensation during sexual stimulation

• Triggering the ejaculation reflex through the spinal cord

 

 

In patients with hypersensitivity of the glans, overstimulation of these nerves causes early onset ejaculation. By selectively removing 2 to 4 of these branches while preserving others, the goal is to reduce the sensitivity enough to prolong intravaginal ejaculatory latency time (IELT) without impairing pleasure or erection.

 

 

 

How the Procedure Is Performed

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Setting:

 

• Outpatient surgical setting

• Usually under local anesthesia + mild sedation

• Duration: 30–60 minutes

 

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 Steps:

 

1. Pre-operative Mapping

   A Doppler or nerve stimulation mapping may be used to identify dominant hypersensitive nerve branches.

2. Surgical Incision

   A 2–3 cm longitudinal incision is made on the dorsal base of the penis, just under the pubic bone.

3. Nerve Identification

   The dorsal neurovascular bundle is exposed, and the dorsal nerves are carefully separated under a surgical microscope.

4. Selective Transection

   2–4 dorsal nerve branches (typically from one or both sides) are cauterized and cut, while the main dorsal artery and deep dorsal vein are preserved.

5. Closure

   The incision is closed in layers with absorbable sutures, and a light dressing is applied.

 

 

 

 

Recovery and Postoperative Care

 

 

Hospital Stay:

 

Most patients are discharged on the same day or after overnight observation.

 

 

Recovery Timeline:

 

• 1–3 Days: Mild swelling, soreness, and temporary numbness around the incision site

• 1 Week: Most daily activities can be resumed

• 3–4 Weeks: Sexual activity can usually be resumed

• 2–3 Months: Full nerve remodeling and effect of sensitivity reduction are evident

 

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Post-op Instructions:

 

• Use antibiotics and anti-inflammatory medications as prescribed

• Avoid intercourse or masturbation for 3–4 weeks

• Wear loose underwear and avoid direct pressure on the surgical site

• Monitor for signs of infection, bleeding, or excessive numbness

 

 

Effectiveness of SDN: What Does the Research Say?

 

Several clinical studies from Korea, China, and Europe have demonstrated SDN’s effectiveness for carefully selected PE patients:

 

• Success rate: 65%–85% of patients report significant increase in IELT (often from <1 minute to 3–6 minutes or more)

• Patient satisfaction: 70%–80% report high or very high satisfaction

• Recurrence rate: <15%, usually related to nerve regeneration or incomplete response

• Re-operation: Rare, but possible in resistant cases

 

 

 Study Highlight:

In a 2022 study published in the Asian Journal of Andrology, 78% of patients experienced over 3-fold increase in IELT after SDN with no erectile dysfunction or loss of pleasure.

 

 

Advantages of Selective Dorsal Neurotomy

 

 Permanent or Long-Term Relief

Unlike medications or creams, SDN offers semi-permanent reduction in hypersensitivity.

 

 Targeted Approach

Only hypersensitive nerves are removed; sexual pleasure is preserved.

 

 One-Time Procedure

No need for continuous medication or therapy.

 

 Quick Recovery

Minimal downtime with fast return to work and intimacy.

 

 Safe in Expert Hands

When performed by experienced microsurgeons, the procedure has low complication rates.

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Risks and Potential Side Effects

 

Like any surgical procedure, SDN carries some risks — especially when performed by inexperienced hands:

 

 Temporary or Permanent Numbness in part of the penis

 Reduced sexual pleasure if too many nerves are removed

 Erectile dysfunction, especially if the main nerve trunk is damaged (very rare)

 Painful neuroma formation (painful scar at the nerve cut site)

 Infection or bleeding at the incision site

 

 Risk Reduction Strategy:

The use of intraoperative nerve monitoring and selective microsurgical technique helps minimize the chance of complications. Only 2–4 nerve branches are targeted to preserve sensation and erection quality.

 

 

Alternatives to SDN

 

Before considering surgery, all patients should first try conservative and non-invasive treatments, including:

 

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Pharmacological Options

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• SSRIs (Paroxetine, Sertraline, Dapoxetine)

• Tramadol (off-label)

• PDE5 inhibitors (Tadalafil) in combination

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Topical Therapies

 

• Lidocaine/prilocaine sprays or creams

 

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Behavioral & Psychological Therapy

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• Cognitive-behavioral therapy (CBT)

• Start-stop techniques

• Squeeze techniques

• Couples counseling

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Novel Regenerative Options

 (off-label)

 

• Platelet-rich plasma (PRP) injections to glans

• Cryoablation

• Glans neurotoxin injections (controversial)

 

 

If these options fail to provide meaningful relief, SDN becomes a valid, evidence-based next step.

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Who Should Avoid SDN?

 

SDN is not recommended in the following situations:

 

 Acquired PE due to stress, depression, relationship problems

 PE caused by prostatitis or urethritis

 Erectile dysfunction or poor erection baseline

 Very low penile sensitivity or numb glans

 Unrealistic expectations or body dysmorphic disorder

 Patients unwilling to follow post-op care instructions

 

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Combined Surgical Options

 

In patients with dual hypersensitivity (both glans and frenulum), SDN may be combined with:

 

 

 Cryoablation or Frenular Neurotomy

 

• Reduces reflexogenic sensitivity from frenular and Glans region

• Can be performed in the same session under local anesthesia

• Effective in men with strong ejaculation reflex triggered by frenulum touch

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Why Choose Our Clinic?

 

At Safe Urology Clinic – Istanbul, we specialize in advanced microsurgical treatments for sexual dysfunctions 

we offer:

 

 Intraoperative nerve monitoring

 Personalized mapping of hypersensitive zones

 Combination treatments (e.g. cryoablation)

 Transparent consultation and expectations

 5-star postoperative care and tele-follow-up

 

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FAQs – Frequently Asked Questions

 

 

Will I lose all sensation in my penis?

 

 

No. Only 2–4 nerve branches are selectively removed. Most men report reduced sensitivity, not complete numbness. Sexual pleasure is usually preserved.

 

 

Can the nerves grow back?

 

 

Yes, some degree of nerve regeneration may occur over 1–2 years, but the long-term benefit often remains.

 

 

Does it affect fertility?

 

No. The procedure does not interfere with sperm production or ejaculation pathways. It only delays the reflex.

 

 

Is this covered by insurance?

 

In most countries, SDN is not covered under public or private insurance plans. Please inquire for package pricing and installment options.

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Conclusion

 

Selective Dorsal Neurotomy is a cutting-edge microsurgical treatment that provides significant, long-lasting relief for men suffering from primary premature ejaculation due to penile hypersensitivity.

 

If you’ve tried creams, pills, and therapy without success, this procedure may be the solution to help you regain confidence, intimacy, and control.