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U UROLOMAX

Sexual Medicine · Istanbul

Premature Ejaculation:
the most common male complaint — and the least treated.

Around one man in three lives with it; barely one in ten ever raises it with a doctor. It is not a character flaw, it is a reflex with measurable causes — and a treatment ladder that works, provided the rungs are climbed in the right order.

~0%of men affected at some point — the commonest male sexual complaint
< 0 minIELT defining lifelong PE under the ISSM criteria
0–0×typical IELT improvement reported with correct stepwise therapy
Confidential sexual medicine consultation for premature ejaculation treatment in Istanbul

The Problem

Years of silence, then the wrong operation.

Men endure PE for a decade on average before speaking, and by then the internet has sold them anaesthetic sprays that numb their partner too, herbal capsules with no active mechanism, and clinics offering to cut nerves on the first visit. Meanwhile the actual driver — early erectile dysfunction, chronic prostatitis, thyroid disease or plain performance anxiety — goes unlooked for. Operating on an undiagnosed cause is how a treatable complaint becomes a permanent one.

The Resolution

Measure the reflex. Then climb the ladder in order.

We begin with an IELT diary and a cause work-up — erectile function scored, thyroid checked, prostatitis excluded. Then, in guideline order: behavioural and pelvic-floor training, topical anaesthetic applied correctly, on-demand dapoxetine or a daily SSRI, and a PDE5 inhibitor where erections are the true culprit. Only refractory lifelong PE with proven hypersensitivity is offered hyaluronic acid glans augmentation or selective dorsal neurotomy — and we say plainly where that evidence is thinner.

The ladder, rung by rung.

Behavioural therapy — stop-start, the squeeze technique and structured pelvic-floor training — is unglamorous and genuinely effective: randomised work shows pelvic-floor rehabilitation alone can multiply IELT several times over in lifelong PE. It costs nothing and it is the rung most often skipped.

Topical anaesthetics (lidocaine–prilocaine spray or cream) reduce glans sensitivity within minutes. The reason they disappoint is almost always application error — wrong dose, wrong timing, no condom barrier, so the partner is numbed too. Applied properly, they are effective and instantly reversible.

Dapoxetine is the only SSRI licensed specifically for PE: taken 1–3 hours before intercourse, it typically triples IELT, and it clears the body quickly. Where on-demand dosing is impractical, low-dose daily paroxetine or sertraline is used off-label with careful counselling about side effects.

Glans hyaluronic acid augmentation increases the distance between nerve endings and creates a physical cushion, reducing sensitivity for roughly a year — reversible, and a rational trial before anything permanent. Selective dorsal neurotomy divides selected dorsal nerve branches under magnification, preserving the main trunk and blood supply. Published series report substantial IELT gains and high satisfaction — and it is also, honestly, the option where the international evidence base is smallest and the change irreversible. We reserve it for refractory lifelong PE with objectively demonstrated hypersensitivity.

First, we look for these

  • Erectile dysfunction — rushing to finish before losing rigidity mimics PE exactly.
  • Chronic prostatitis — a well-documented and treatable driver of acquired PE.
  • Thyroid dysfunction — hyperthyroidism shortens IELT and reverses on treatment.
  • Anxiety and relationship factors — dominant in acquired, situational PE.

A meaningful share of men referred for PE surgery leave with a prescription and a plan instead — because the cause was never the nerve. If that is you, we will tell you.

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How treatment actually unfolds.

  1. Before travel — the IELT diary

    A two-week stopwatch diary plus validated questionnaires (PEDT, IIEF) turn a subjective complaint into a number. Most treatment decisions are already visible at this stage.

  2. Day one — cause work-up

    Hormone panel including thyroid, prostatitis screen, penile Doppler where erectile function is in doubt, and biothesiometry to measure glans sensitivity objectively rather than assume it.

  3. Day one — the medical plan

    Behavioural programme, correctly demonstrated topical technique, and a pharmacological regimen you take home. For most men, the journey ends here — successfully, without an operation.

  4. Day two — procedure, only where indicated

    Glans hyaluronic acid augmentation takes about 30 minutes under local anaesthesia. Selective dorsal neurotomy takes 45–60 minutes under sedation through a discreet incision, as a day case.

  5. Weeks two to twelve — measured follow-up

    Intimacy resumes at three to four weeks after a procedure. Your IELT is re-measured against your own baseline through the encrypted channel — evidence, not reassurance.

Answered without euphemism.

What actually counts as premature ejaculation?
Three things together: ejaculation within about a minute of penetration (lifelong) or a drop to roughly three minutes (acquired), an inability to delay it, and real personal distress. A short time on its own is not a diagnosis — and the average for men without PE is far shorter than pornography suggests.
Should I go straight to the nerve surgery?
No. EAU and AUA guidance places selective dorsal neurotomy as an option for refractory lifelong PE with demonstrated hypersensitivity, after medical therapy has genuinely failed. It is irreversible and its evidence base is smaller than for drugs. Clinics that offer it on the first visit are skipping the steps that help most men.
Will the treatment numb my partner too?
Only if the anaesthetic is used incorrectly. Applied at the right dose and timing, wiped before intercourse or used with a barrier, transfer is negligible. Glans hyaluronic acid augmentation avoids the issue entirely, since nothing is applied to the surface.
Is it permanent, or will it come back?
Behavioural gains persist while the technique is practised. Dapoxetine works per dose. Hyaluronic acid lasts around a year. Neurotomy is permanent. That is exactly why the ladder exists — you learn what works for you before choosing something you cannot undo.

Ten years of silence ends with one message.

Describe it in your own words, in complete confidence. A sexual medicine specialist — not a call centre — replies within one business day.

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