Nerve Ablation and Premature Ejaculation

ACCORDING to Oxford Dictionary, ablation is “the removal or destruction, especially of organs or growth, or harmful substances from the body by mechanical means, as by surgery”.

I’ve encountered ablative therapies using “mechanical” means such as cryotherapy, radiofrequency or heat ablation to destroy the growth or unwanted organs from the body.

These days, the applications of such interventions have been extended beyond cancers and tumours.

We explore the feasibility and usefulness of the ablative therapy in sexual health, namely for the treatment of premature ejaculation (PE).

Dear Dr G,

I am 25 years old and I am very frustrated.

I started having sex when I was 21 years old and realised something is not quite right. I am quite sure I suffer from premature ejaculation.

On average, I ejaculate about one minute following intercourse, however, this can also be much faster when I am excited.

I went to see a doctor who told me I am too sensitive.

He recommended a cream to numb the penis. I admit it works, but it kind off take the fun out of intimacy.

I have also tried “squeeze” and start-stop techniques. But this is a waste of time.

The last treatment I received was depoxetine. The tablets although appears to be effective, did not help much.

I read on the Internet there is a technique on ablating the nerve that is too sensitive. Do you know much about this intervention?

Can you tell me where is this available and what are the long-term effects.

I look forward to your reply.

Regards

Desperate

Premature ejaculation is arguably the most common sexual dysfunction affecting men.

In a recent study of the Asia Pacific PE Prevalence and Attitude (APPEPA), PE was noted to affect one in three men in Asia Pacific Nations, especially in countries like South Korea and China.

According to the International Society of Sexual Medicine (ISSM), the diagnosis of PE must meet three criteria.

These include the shortened interval of intercourse with the average time of around one minute from the point of penetration to ejaculation, lack of control and subsequently, rendering distress in the sufferers and their partners.

The exact etiology of PE is unknown. Leading researchers in sexual health agree on the equal causative roles of increased sensitivity in the penis and deranged neurotransmitters in the largest sexual organ, the brain. (Many men may disagree the brain is actually the largest sexual organ in humans).

The focus of therapy in PE has always been reducing the sensation of the penis. The manoeuvres such as the stop/start and squeeze techniques by the famous sexologist couple, Maters and Johnson, has been introduced since the 50s, and are still utilised by many clinicians in the 21st century.

Needless to say, the techniques are not so popular as the main aims are simply stopping sex or inducing pain to lessening stimulation prior to the point of no return.

Until today, most of the therapy efforts have been focusing on dampening the sensation of the penis. These include the applications of local anaesthesia or numbing agents such as SS cream.

Imagine applying minyak angin (medicated oil) to your private parts and having sex with no sensation. Of course, the numbing effects will also affect your partner.

The use of surgery to reduce the sensitivity of penis has also been proposed as a cure for PE. In the 60s and 70s, the foreskins had been noted as the main cause of stimulation to the glans penis.

Despite many men with PE having the snip, the problem of early ejaculations persists.

In recent years, the treatment of suppressing the sensation of the penis by destroying the dorsal penile nerve with cryoablation has been introduced. This has stirred some excitement amongst desperate sufferers of PE.

A recent study was carried out based on 24 subjects with PE who underwent percutaneous CT guided freeze destruction of dorsal penile nerve, responsible for the conduction of penile sensation to the brain.

The results showed increased interval of intercourse from the baseline of 55 seconds to 256 seconds by day seven.

This is gradually decreased to 180 seconds in three months and 140 seconds in one year. Although the study did not reveal any procedure related complications, such intervention is still considered experimental and not endorsed by ISSM.