Causes of premature ejaculation (ejaculation)
Depending on the time of development, rapid ejaculation occurs:
- Primary. Early ejaculation occurs from the very beginning of sexual activity. The main reasons are a short frenulum of the penis, increased sensitivity of the glans.
- Secondary. Premature ejaculation develops under the influence of external factors - these are urological diseases such as balanoposthitis, prostatitis, etc., as well as hormonal disorders, metabolic failures, medication, and genetic factors. The solution to the problem will be treatment of the underlying disease. Sometimes secondary early ejaculation is situational (rapid ejaculation with excessive arousal, frequent masturbation, prolonged sexual abstinence).
Rehabilitation period
After denervation, slight swelling, minor hemorrhages, and hematomas may appear on the penis. All this goes away on its own within a few days.
Rehabilitation after denervation using the open method lasts about a week. One day after the operation, the patient is allowed to go home, then he comes in every day for 10 days for dressings (it is not recommended to wet the bandage for the first 3-5 days). You can perform this manipulation yourself. Some clinics discharge you on the day of surgery literally within a couple of hours. Recovery after blind denervation takes about three weeks (scars take longer to heal than sutures). The pain usually lasts no more than two days.
During the period of complete rehabilitation (2-3 weeks) you cannot:
- Have sex, masturbate, ride a bike;
- Work out in the gym, lift weights;
- Overheat;
- Drink alcohol.
The patient is completely discharged one month after the follow-up examination.
Who should undergo penile denervation in a Ufa clinic?
Suppressing the nerve trunks that lead to the head of the penis will prolong sexual intercourse several times, as a result of which the man will forget about premature ejaculation. As a result of denervation, the sensitivity of the penis decreases, and the duration of intimacy between partners increases.
The operation is indicated for men whose premature ejaculation is caused by increased sensitivity of the head. One of the conditions for the effectiveness of treatment is regular sex life with a regular partner.
Types of denervation and degree of effectiveness of operations
Doctors warn that the main condition for the effectiveness of denervation is the presence of a permanent sexual partner and regular sex life. Otherwise, the necessary reflex will not be developed, and sex will again be short.
According to the method of fiber cutting, several types of denervation are distinguished:
- Full. All nerves going to the head are cut completely, without subsequent stitching (in some cases, pieces of tissue between the ends of the nerves are even removed). The sensitivity of the head disappears for about 3-9 months. The duration depends on the speed of nerve germination. During this time, a new sexual reflex should be developed - the man learns to control emotions, gets used to the normal duration of sexual intercourse, psychological attitudes change, and confidence appears.
- Selective (selective, mosaic). Only individual fibers are cut off, and the sensitivity of the head is partially lost.
- Temporary (renervation). The nerves are first dissected and then stitched together (immediately) with a thin self-absorbing thread (such as Polysorb). The effect lasts for 2-3 months. The technique is currently practically not used, since nerves grow together without suturing.
After normal or complete denervation, the sensitivity of the head disappears completely; this should not be alarmed. Gradually she will return.
Urologist-andrologist Denis Anatolyevich Cherepanov talks about how the denervation operation is performed.
Denervation can be performed using a closed (blind) or open method. In the first case, local anesthesia is sufficient. The doctor probes the nerves and cuts them virtually “by eye”. For this purpose, radiosurgery, laser and acupuncture diathermocautery are used. After the procedure, small scars remain in the form of dots and dashes. A positive result of denervation is achieved in 85-90% of patients.
With open access (microsurgical denervation of the penis), an incision is made on the shaft of the penis around the head with a scalpel, the skin is pulled back, and the nerves are isolated. Their suppression is carried out with a bloodless knife of the Surgitron type. The skin is then returned to its place, distributed and sewn to the head. All manipulations are performed under the control of an operating microscope (type Olympus SZX7). Subsequently, the retracted flap grows to the subcutaneous layer. The operation lasts about half an hour; upon completion, an aseptic circular bandage is applied to the penis. General or spinal anesthesia is used. Efficiency ranges from 95 to 99%. There are no scars, seals or adhesions left.
The duration of sexual intercourse after complete restoration of nerve fibers is on average 10-15 minutes, for some men it is more than an hour.
With the selective denervation method, for example, all lateral branches are cut off, and only 30% on the back of the penis.
During denervation, the foreskin can be removed (circumcision) or left - at the request of the patient; at the same time, plastic surgery of the frenulum is also possible. These measures increase the efficiency of the operation.
Scheme of frenuloplasty
The average cost of denervation is from 55 thousand rubles. The most competent specialists in this field are considered to be Sokolshchik M. M. (FGU "Treatment and Rehabilitation Center" of the Ministry of Health and Social Development, Moscow), Petrovich R. Yu. (PolyClinic Otradnoe, Moscow). In St. Petersburg, denervation can be done, for example, at the SM Clinic, at the Pirogov Clinic. The price for the entire package of tests, surgery, 6 hours in the hospital is 50,370 rubles.
Indications for denervation of the glans penis
Surgical treatment aimed at reducing the sensitivity of the penis is recommended for rapid ejaculation:
- before the penis is inserted into the vagina (repeated erection occurs after a long period of time);
- when inserting the penis;
- after several frictions.
The problem for men with an overly sensitive head of the penis is that sexual intercourse lasts on average 2-3 minutes. Truncation of nerve endings allows you to significantly prolong intimate contact and cope with the problem of rapid ejaculation.
Regarding contraindications to surgery (denervation) in our clinic in Ufa, the following can be highlighted:
- inflammatory diseases with fever;
- lung and heart diseases;
- exacerbation of chronic diseases;
- blood diseases;
- hypersensitivity to drugs used during surgery;
- malignant neoplasms;
- sexually transmitted infections.
Can the problem be eliminated with medications?
There is medical treatment, which includes taking antipsychotics. But, unfortunately, they significantly change the quality of life. Without surgery, the problem can only be dealt with through the constant use of lidocaine or condoms with anesthetics.
Lidocaine test
A lidocaine test is carried out in order to understand whether surgical intervention to combat hypersensitivity is suitable for a man or not (microsurgical denervation of the glans penis).
Lidocaine
is a drug that blocks nerve endings. 30-40 minutes before sexual intercourse, a man takes a 10% lidocaine solution and applies it to the penis, most of it on its distal third, closer to the head. This will help block the nerve endings. Then the remnants of the drug must be washed off so that there is no anesthesia of the vagina, and sexual intercourse can begin.
If a man sees that this procedure has helped and he can control sexual intercourse, then, accordingly, this surgical technique is for him. The fact is that blocking the nerve endings ensures that ejaculation occurs not from the nerve endings, but from the brain, that is, when the man is emotionally ready for it.
Indications
The indication for denervation is ejaculation that occurs prematurely: before insertion of the penis into the vagina, during insertion, or immediately after the first frictions (within a minute). The nature of the problem must be permanent.
It is important to note that denervation does not give 100% results . This means that even if the glans has lost sensation, ejaculation may still occur prematurely. In order not to be disappointed with the result, you first need to make sure that the cause of the problem is in the inverter head . To do this, a lidocaine test is performed (independently at home using any anesthetic - Emla, 10% lidocaine).
There are 2 testing methods:
- Selective - only the frenulum and the area around it are lubricated, then protected sexual intercourse is performed. If its duration has increased, and the quality of erection and the degree of sensations during orgasm have not been affected, then you can do without denervation. It is enough to trim the foreskin and perform frenuloplasty. In this case, lateral denervation may also be advisable, in which only the fibers passing along the sides of the penis are cut off (they innervate the frenulum and the bottom of the head);
- Full – the entire surface of the head is processed. This is performed if the first method failed to achieve a pronounced effect. As the time of sexual intercourse increases, it makes sense to perform total or selective denervation.
Urologist-andrologist, surgeon Anton Vasilievich Babykin more about the test with an anesthetic
If the time of sexual intercourse after treating the head with both methods has not increased significantly, then it is not advisable to suppress the nerves - the problem of premature ejaculation will not be solved.
Even a positive test result is not always an indication for denervation. During a preliminary examination of the patient, the clinician must distinguish early ejaculation from erectile dysfunction . If premature ejaculation is not permanent and does not cause significant suffering, then there are no indications for denervation. The patient’s age, concomitant diseases, and sexual experience are also taken into account.
Patient preparation
Before denervation, a standard set of tests :
- Blood: general and biochemical tests, serum testing for hepatitis, HIV, coagulation. Rh and blood type must be known.
- General urine analysis.
- ECG (if the operation is performed under general anesthesia).
- Chest X-ray.
If the patient does not have chronic diseases, is overweight, is under 40 years of age, and denervation is performed under local anesthesia, then at the doctor’s discretion, you can limit yourself to only the first point. A complete list of tests is necessary in the presence of chronic pathologies, when performing an operation under general anesthesia. Test results are valid for a month.
Complications
At the moment of isolating the nerves, the main thing for the doctor is not to damage the veins and arteries passing nearby. Therefore, it is important that the clinic is equipped with microsurgical instruments and optical equipment. When the vessels are damaged, extensive hemorrhages occur and the nutrition of the head of the penis is disrupted.
After denervation, there is a possibility of developing infectious and inflammatory diseases. A hematoma can become a source of inflammation with possible suppuration. In such cases, the wound surface is drained and washed, and antibiotics are prescribed.
Properly performed denervation does not lead to a deterioration in erection (contrary to rumors). Some men begin to fear sex on a subconscious level due to pain. After a month, it is possible and necessary to resume sexual activity, since otherwise the effect of denervation is reduced.
Progress of the operation
Microsurgical denervation is performed under local, general or spinal anesthesia using microscopes with a high degree of optical magnification . Does not require long-term hospitalization. Only highly qualified doctors can afford to perform the procedure under local anesthesia.
During the operation, under the coronary sulcus, the skin is cut along the entire circumference of the penis, then pulled back to the base of the penis. Nerve fibers are extracted from the tissue using a special instrument. The doctor dissects the required number of trunks, then, using microsurgical techniques, sews them back together (during renervation) or leaves them free. The procedure lasts from 30 minutes to an hour. After the operation, the patient remains under the supervision of a doctor for 3-4 hours, then is discharged .
Urologist-andrologist Denis Anatolyevich Cherepanov talks about how the operation goes.
In addition to surgery, there is also a non-invasive method of destroying nerve trunks - radiofrequency denervation (using high-frequency currents). The doctor identifies the most sensitive fibers by touch and targets them with radiation. Radiofrequency denervation of the head is not popular due to low efficiency.
