Premature ejaculation is a common male sexual dysfunction, and the current treatment methods mainly include behavioral therapy (such as sexual concentration training), oral medication, local topical medication, physical therapy and Chinese medicine treatment. However, the intervention effect of the above clinical treatment has certain difficulties and limitations, and there are problems such as inconvenience, difficulty in adherence or often no good cooperation from sexual partners, and the efficacy also varies greatly depending on the target.
In recent years, it has been shown that penile sensory hypersensitivity or hyperexcitability of penile sensory nerves is one of the causes of premature ejaculation. In 1993, Tullii et al. reported the treatment method of dorsal penile nerve block (excision), and in China, Zhang Chunying carried out this operation in September 2001. In recent years, this procedure has been increasingly used in China, but it is mostly limited to private hospitals.
The International Society of Sexual Medicine clearly pointed out in the latest “2014 Guidelines for the Diagnosis and Treatment of Premature Ejaculation” that “dorsal penile nerve excision may lead to permanent loss of sexual function and is not recommended for the treatment of premature ejaculation”. However, in China, due to the lack of supervision, a large number of private hospitals are trying to claim that “the surgery solves the trouble of premature ejaculation”, which is used as a gimmick to solicit patients and even becomes the first choice of treatment for premature ejaculation patients.
The theoretical basis of surgical treatment of premature ejaculation
The surgery cuts off part of the sensory nerve, causing the sensitivity of the penis head to decrease, and the nerve impulse afferent to decrease, thus prolonging the time for the ejaculatory nerve to reach the excitement threshold.
Surgical method
After the penis is anesthetized, an incision is made on the dorsal side of the penis, the skin and fascia are cut in turn, and the dorsal penile nerve is dissected out, and several branches are seen entering the head of the penis. Postoperative period: 1 week
The stitches are removed in 1 week after surgery, and sexual intercourse begins in about 1 month.
Who is it for?
The procedure requires strict indications and is only suitable for married patients with extremely sensitive penile ejaculation, and the patient must have received long-term medication and psychological and behavioral treatment with little effect. Also, a professional measurement of the penis is required before the surgery, and then a comprehensive judgment is made after obtaining objective data. Specifically, the surgical target should also have the following conditions.
(1) Normal erectile function;
(2) Married or with a regular sexual partner, with a regular sexual life of >1 year;
(3) Severe premature ejaculation;
(4) No other organic factors;
(5) Normal psychological quality;
(6) Effective local anesthetic applied to the penis;
(7) Wearing condom is effective;
(8) Conventional sexual behavior therapy >2 months is still ineffective;
(9) Generally <40 years of age, or >40 years of age with a strong desire for surgery.
Surgical efficacy
The recent efficiency of dorsal penile nerve dissection has been reported to be close to 90% in China, but the inefficiency rate reported in foreign literature is about 40% or more. The reason for the large difference in data is unclear and may be related to the patients selected for this method and the specific surgical approach (e.g., the number of dorsal penile nerve branches cut during surgery). Obviously, if the main cause of the patient’s morbidity is not due to increased sensitivity of the dorsal penile nerve, the results will not be satisfactory.
In terms of long-term outcomes, accurate data are lacking and further long-term, close follow-up is needed.
Complications of surgery
In addition to possible common complications such as infection, bleeding, and incisional dehiscence, dorsal penile nerve block can easily lead to increased complications such as penile numbness and erectile dysfunction (ED) if too many branches of the dorsal penile nerve are severed. In general, partial severance of the dorsal penile nerve branches does not affect erectile function, but it may cause numbness and a marked lack of sensation in the penis, which can diminish the function of reflex erection and affect erectile function. Because elderly men themselves are prone to ED, this procedure is not suitable for elderly people or patients with premature ejaculation combined with ED.
Problems and controversies
In recent years, the treatment of premature ejaculation by dorsal penile nerve block has been reported both at home and abroad, and may have some efficacy, but its safety and long-term effects still need further study. Meanwhile, due to the complex physiological process of the ejaculatory reflex, there are few basic studies related to it, and the detailed mechanism of many links is still unclear, so the theoretical basis of this procedure is not sufficient. In addition, the number and length of nerve branches to be excised and the way of excision have yet to be explored and summarized in the subsequent clinical practice.
In view of this, the International Medical Association clearly pointed out in the newly released 2014 Guidelines for the Diagnosis and Treatment of Premature Ejaculation that “dorsal penile nerve excision may lead to permanent loss of sexual function and is not recommended for the treatment of premature ejaculation”. However, in China, due to the lack of supervision, a large number of private hospitals are trying to claim that “the operation solves the trouble of premature ejaculation”, using this as a gimmick to solicit patients, and even become the preferred treatment for premature ejaculation patients.
In conclusion, the surgery is invasive, and its effectiveness and specific modalities are still very controversial, and its safety and long-term effectiveness are still uncertain and far from being promoted. Therefore, doctors and patients must be cautious before choosing surgical treatment.