A Lasting Solution for Premature Ejaculation: What Is Neurectomy (SDN) Surgery?

A Lasting Solution for Premature Ejaculation: What Is Neurectomy (SDN) Surgery?

Premature ejaculation is the most frequently encountered condition in male sexual health, and it causes serious psychological strain between partners as well as physical difficulty. Many men turn to temporary solutions while struggling with the problem: delaying sprays, creams, strong psychotropic medication or behavioural exercises. These methods generally provide momentary relief, and the problem resumes as soon as they are stopped.

But what if the premature ejaculation is caused by physical, anatomical hypersensitivity? It is here that Selective Dorsal Neurectomy (SDN), the neurectomy operation for premature ejaculation, comes into play, standing out in andrology for its lasting results.

In this guide we have brought together all the detail about the SDN operation performed by Op. Dr. Taylan Yanar at our clinic in Mavisehir, Izmir.

The Anatomical Cause of Premature Ejaculation: Hypersensitivity of the Glans

In a significant proportion of men with premature ejaculation the underlying problem is not psychological but neurological. The glans penis has the densest nerve network through which sexual stimulation is transmitted to the brain. In a normal anatomical structure these nerve fibres carry a balanced level of stimulation, but in some men:

1. There may be a greater number of nerve branches in the glans than normal.
2. The stimulation threshold of the nerve endings may be very low.

This causes an excessive volume of signals to reach the brain's ejaculation centre within seconds of sexual contact beginning, so that ejaculation occurs beyond the man's control. Whereas delaying creams and sprays attempt to eliminate sensation by numbing the area completely, neurectomy surgery resolves the problem at its root and in a balanced way.

What Is Selective Dorsal Neurectomy (SDN)?

Selective Dorsal Neurectomy (SDN) is the selective division, using microsurgical techniques, of the excess nerve fibres responsible for hypersensitivity of the glans.

The critical word here is "selective". The aim of the operation is not to eliminate sensation in the glans but to bring the hypersensitivity (hyperaesthesia) down to the standard level of a healthy man.

A way of thinking about it:
If the light in a room is too bright for your eyes, you do not dismantle the entire electrical installation; you simply switch off the excess bulbs and bring the room to an ideal level of brightness. SDN surgery works on exactly this principle.

Who Is Neurectomy Surgery for Premature Ejaculation Suitable For?

Neurectomy surgery is not applied directly to every patient with premature ejaculation. In line with the principle of the right treatment for the right patient, the candidate must meet certain criteria.

The ideal candidates for SDN surgery are:

• Those with primary premature ejaculation: men who have consistently ejaculated in under one minute since their first sexual experience.
• Those found to have hypersensitivity of the glans: patients in whom hypersensitivity is confirmed by clinical examination or by penile biothesiometry (a sensation test).
• Those who gain no benefit from temporary methods: patients who achieve no lasting improvement despite medication, creams, sprays or sexual therapy.
• Those seeking a day-case, lasting solution: patients who do not wish to use medication or sprays for life.

How Is SDN Surgery Performed? The Process Step by Step

This operation, which requires microsurgical experience, is carried out in a highly practical manner with patient comfort in mind:

1. Pre-operative assessment

In a detailed examination by Op. Dr. Taylan Yanar the patient's anatomy is assessed and it is confirmed whether the problem is neurogenic in origin.

2. The operation

• Anaesthesia: the procedure is generally performed under local anaesthesia or light sedation. The patient feels no pain or discomfort.
• Micro-incision: a small incision of 1 to 2 cm is made just above the circumcision line, along an aesthetic contour that leaves no visible mark.
• Nerve mapping and microsurgery: under a high-magnification operating microscope the main dorsal nerve of the penis and the fine branches running from it to the glans are isolated one by one.
• Selective division: guided by testing and surgical experience, between 30 and 50 per cent of the excess nerve branches causing over-stimulation are carefully divided. The main nerve trunk and the structures responsible for erection are never touched.
• Closure: the incision is closed with aesthetic, self-dissolving sutures.

3. Recovery

• The operation takes 45 to 60 minutes on average.
• After a few hours' rest the patient can walk home the same day.
• Return to desk work and social life generally takes two to three days.
• Approximately four weeks of sexual abstinence is observed so that tissue healing is complete and the nerves adapt to the new balance.

Comparison: SDN Neurectomy or Other Treatments?

SDN neurectomy offers a lasting result, whereas creams and tablets work only for as long as they are used.

Understanding how the methods used in premature ejaculation treatment differ from one another will help you make the right decision:

SDN neurectomy

• Duration of effect: permanent, lifelong.
• Advantages: a single procedure, life without medication, a high success rate.
• Consideration: it is a surgical intervention.

Delaying creams and sprays

• Duration of effect: temporary, 20 to 30 minutes.
• Advantage: easily obtained.
• Consideration: can eliminate sensation entirely and may transfer to the partner.

Oral medication (SSRIs)

• Duration of effect: only while being taken.
• Advantage: practical to use.
• Consideration: side effects such as headache and loss of desire; the problem returns when stopped.

Glans filler

• Duration of effect: 12 to 18 months.
• Advantage: non-surgical and practical.
• Consideration: must be repeated at intervals.

Common Misconceptions About SDN Neurectomy

Hearsay about neurectomy surgery for premature ejaculation can cause patients unnecessary concern. The medical facts are as follows:

Myth 1: "Neurectomy surgery impairs erection."
Fact: the vascular and nerve bundles that provide erection (the cavernous nerves) lie deep within the penis. SDN surgery is performed only on the superficial sensory nerves just beneath the skin. The erection mechanism is not even physically touched.

Myth 2: "After the operation the glans is completely numb and I will feel no pleasure."
Fact: the aim of the operation is not to reduce sensation to zero but to bring excessive sensation down to a normal level. Because the main nerve is preserved, the sense of touch and sexual pleasure continue in full; indeed, sexual satisfaction increases thanks to the longer duration of intercourse.

Myth 3: "It prevents a man from having children and affects sperm quality."
Fact: SDN surgery has no bearing whatsoever on sperm production, the seminal ducts or fertility.

Frequently Asked Questions

Does neurectomy surgery for premature ejaculation provide a lasting solution?

Yes. Because the divided nerve fibres do not rejoin on their own, the balance of sensitivity in the glans is preserved permanently. The procedure therefore offers a lifelong improvement.

How long does SDN surgery take and is a hospital stay required?

The operation is completed by microsurgical technique in 45 to 60 minutes on average. It is a day-case procedure; the patient is discharged the same day without needing to stay overnight in hospital.

Will there be a scar after the operation?

Because the incision is concealed within the circumcision line and aesthetic suture materials are used, no noticeable surgical scar remains once healing is complete.

How long after the operation can sexual intercourse resume?

To allow the tissue to heal fully and to prevent any risk of infection, it is recommended to avoid sexual intercourse and masturbation for four weeks after the operation.

Conclusion: Take Back Control of Your Sexual Life

Premature ejaculation is not a fate you must accept, and you do not have to live dependent on delaying products for life. If hypersensitivity of the glans lies at the root of your problem, Selective Dorsal Neurectomy (SDN) can offer you a lasting, comfortable and reliable solution.

To obtain information about the diagnostic and treatment processes carried out under Op. Dr. Taylan Yanar at our Andrology Clinic in Izmir, and to create a treatment plan tailored to you, you can contact our clinic.