Treatment
Premature Ejaculation

From behavioral therapy to the EjaNova® procedure

Premature ejaculation is the most common sexual dysfunction in men — and at the same time the one that is least specifically treated. Yet today well-documented, effective treatment options are available: from simple behavioral techniques to the surgical solution with the EjaNova® procedure.

This page presents all treatment options in detail — with their mechanisms of action, indications and the study evidence. So that you and your doctor can choose the right path together.

Premature ejaculation — get treatment now

Initial consultation via video consultation · Medical history questionnaire in advance · Surgical procedure in the on-site clinic.

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All treatment options at a glance

The treatment depends on the type of PE (primary/secondary), the suspected cause and the level of distress. In many cases, a combination of several methods is most effective.

Method	Onset of effect	Sustainability	Best suited for
Behavioral techniques	Practicable immediately	Medium — requires continuous training	Mild/moderate PE, psychological component
Topical local anesthetics	Immediately upon application	Symptomatic — only acts acutely	Hypersensitivity, rapid relief
Dapoxetine (SSRI, as needed)	30–60 min. after intake	Symptomatic — no lasting effect	Primary PE, biological cause likely
SSRI daily (off-label)	2–4 weeks	Medium — persists with intake	Primary PE, if as-needed SSRI is not sufficient
Psychosexual therapy	Weeks to months	High — resolves the root cause	Secondary PE, anxiety component, partnership
EjaNova® procedure	From week 4–12 post-op	Permanent — structural change	Primary PE with hypersensitivity, conservative failure

Behavioral techniques: The first step

Behavioral therapy methods are the basis of every PE treatment — free of charge, immediately applicable and without side effects. They train conscious control over the ejaculation reflex.

Start-stop technique (according to Semans)

Sexual stimulation is interrupted just before the point of orgasmic sensation until the arousal subsides — then it is continued. Through regular practice, the man learns to better perceive and control the threshold of ejaculation. Suitable both alone and with a partner.

Squeeze technique (according to Masters & Johnson)

Just before orgasm, the glans is firmly squeezed between the thumb and two fingers for 10–20 seconds — this dampens the ejaculation reflex. It requires active participation of the partner and good communication. It shows particularly good results in couples therapy.

Both techniques require patience — improvements appear after 4–8 weeks of regular practice. In cases of primary PE with a biological cause, they alone are often not sufficient.

Pharmacological therapy: Topical and systemic

Topical local anesthetics (lidocaine/prilocaine)

Anesthetic creams or sprays based on lidocaine and prilocaine are applied to the glans 15–20 minutes before intercourse. They specifically reduce penile sensitivity and thus prolong the time to ejaculation.

Advantage: Immediate effect, no systemic side effects
Disadvantage: Must be applied every time, can reduce sensitivity excessively
Condoms recommended: Prevents unintentional anesthesia of the partner

Dapoxetine (Priligy®) — the only active substance approved for PE

Dapoxetine is a short-acting serotonin reuptake inhibitor (SSRI) that was specifically developed for the treatment of premature ejaculation and is approved in Germany. Unlike other SSRIs, dapoxetine acts very quickly (1–2 hours after intake) and is designed for on-demand use.

Dosage: 30 mg or 60 mg, 1–3 hours before intercourse
Efficacy: Prolongation of the IELT by 2–4 times in clinical studies
Side effects: Nausea, dizziness, headache (especially at 60 mg)
Contraindications: MAO inhibitors, certain heart conditions, renal insufficiency — medical prescription required

Daily-taken SSRIs (off-label)

Certain SSRI antidepressants (e.g. sertraline, paroxetine, fluoxetine) can prolong the ejaculation time when taken daily — as a side effect of their serotonergic action. This is an off-label use that can be considered in cases of primary PE with a biological cause and a high level of distress.

Important: Daily-taken SSRIs require careful medical consideration — they have a side-effect profile that makes continuous medication unsuitable for every patient.

Which treatment suits you?

A 30-minute conversation with the specialist clarifies this — with a medical history questionnaire in advance and an individual treatment plan.

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The EjaNova® procedure:
The surgical solution for primary PE

The EjaNova® procedure is the surgical treatment of choice for men with primary, lifelong PE and proven hypersensitivity of the glans, when conservative therapies have not been sufficiently effective. It is a selective denervation of the dorsal penile nerves (SRDN — Selective Resection of Dorsal Nerves) — a minimally invasive procedure that specifically interrupts the oversensitive nerve fibers without affecting the structures important for erection and sensation.

The procedure is performed personally at the AndroKlinik by Dr. med. Timo A. Spanholtz — at the locations of the private clinic Praxisklinik am Rosengarten.

Requirements for the EjaNova® procedure

Primary (lifelong) ejaculatio praecox with an IELT typically under 1 minute
Proven penile hypersensitivity — measured by biothesiometry (vibration sensitivity measurement)
Insufficient response to conservative treatment attempts
Exclusion of a primary psychological cause and organic underlying diseases
Detailed explanation and informed consent after preliminary examination

Results in comparison:

Measure	SRDN group (n=40)	Control group circumcision (n=61)
IELT preoperative	1.1 ± 0.9 minutes	1.2 ± 0.7 minutes
IELT postoperative	3.8 ± 3.1 minutes (p < 0.01)	1.5 ± 1.1 minutes (p > 0.05, n.s.)
IELT change	+245 % — statistically significant	+25 % — not significant
Erectile function	Not impaired (BMSFI* unchanged)	Not impaired
Patient satisfaction	Significantly improved	No significant change

* BMSFI = Brief Male Sexual Function Inventory. The decisive finding: erectile function remained fully preserved in the SRDN group — a central safety criterion of the procedure.

Confirmation study

A confirmation study (Liu et al., Journal of Sexual Medicine, 2019) replicated these findings in another randomized design: the IELT increased from 1.2 to 4.31 minutes after SRDN. Patient satisfaction with their sex life improved from 23 % to 61 % (p < 0.01). In this study too, erectile function remained unaffected.

Clinical interpretation of the study data

A prolongation of the IELT from 1.1 to 3.8 minutes (+245 %) sounds modest on paper.
For men who have faced an IELT under 1 minute their entire lives, this difference is transformative: from uncontrollable failure to sufficient control — and thus to a fundamentally different sex life.
The statistical significance (p < 0.01) and the lack of effect in the control group prove that this effect is attributable to the selective denervation and is not a placebo effect.

Course of the EjaNova® procedure: Step by step

The procedure is outpatient, minimally invasive and generally well tolerated. Here is the exact course:

	Phase	What happens
1	Preliminary examination & biothesiometry	Measurement of penile sensitivity with the biothesiometer — quantitative confirmation of the hypersensitivity. Detailed explanation by Dr. Spanholtz, establishment of indication, surgical planning.
2	Preparation	Outpatient admission at the private clinic K61. Local anesthesia or light sedation depending on patient preference. No general anesthesia required.
3	The procedure (approx. 60–90 min.)	Precise skin incision in the area of the penile shaft. Selective identification and interruption of the dorsal nerve fibers responsible for hypersensitivity. Preservation of all structures important for erection and basic sensation.
4	Wound care & recovery	Sterile dressing. Short monitoring phase. Discharge on the same day. Slight sensitivity and swelling in the first few days are normal.
5	Aftercare (week 1–4)	Protection of the treated region, no sexual activity. Follow-up appointment after 1–2 weeks. Antibiotic coverage as needed.
6	Full recovery (from week 4–6)	Return to normal activity including intercourse. The full effect becomes apparent with the increasing normalization of sensitivity — evaluation after 3 months recommended.

Safety and possible risks

As with any surgical procedure, there are risks about which the patient is comprehensively informed before the procedure. With careful patient selection and an experienced surgeon, the risk profile of the EjaNova® procedure is low.

Possible risks — full explanation before the procedure

Usual surgical risks: secondary bleeding, infection, wound healing disorder (rare)
Overcorrection: Too strong a reduction of sensitivity — rare, minimized with an experienced surgeon
Undercorrection: Insufficient effect — in this case a subsequent correction can be considered
Temporary sensitivity changes: Normal in the first weeks after the procedure
Erectile function: Not impaired in clinical studies (Zhang 2012, Liu 2019) — no increased ED rate

Not suitable for men with: a primary psychological cause · secondary PE without a hypersensitivity finding · active infections

Psychosexual therapy:
When the cause lies in the experience

In cases of secondary PE or when performance anxiety and fear of failure are essential components, psychosexual therapy is the most effective treatment. It can be used independently or as a complement after an EjaNova® procedure, when psychological patterns have contributed to the situation.

Possible therapies

Cognitive behavioral therapy (CBT) — changes dysfunctional thought patterns around sex and performance
Sensate focus exercises — structured physical exercises for desensitizing performance pressure
Couples therapy / sex therapy — when partnership dynamics maintain the PE

At the AndroKlinik we coordinate the referral to specialized sex therapists and psychologists as needed.

Ready for the next step?

Initial consultation via video · Preliminary examination in the clinic · EjaNova® procedure performed personally by Dr. Spanholtz.

Book a consultation now

Frequently asked questions about the treatment of premature ejaculation

How do I decide whether EjaNova® is suitable for me?

The decision is made after a structured preliminary examination by Dr. Spanholtz: medical history (type of PE, duration, level of distress), biothesiometry to measure penile sensitivity, and exclusion of psychological or organic underlying diseases. If all criteria are met, the procedure is classified as suitable — together with you, not for you.

What is biothesiometry?

Biothesiometry measures the vibration sensitivity of the penis with a small vibration probe. Thresholds are measured from which vibrations are perceived — in cases of hypersensitivity these thresholds are significantly lower than the normal range. The device is non-invasive, and the examination takes a few minutes.

Can I still experience orgasm normally after EjaNova®?

Yes. The goal of the procedure is not complete numbness, but a normalized sensitivity. Orgasm and ejaculation are preserved — only the oversensitivity that leads to the premature triggering of the reflex is reduced. In the clinical studies, patients report unchanged or improved sexual satisfaction.

How long does the effect of the EjaNova® procedure last?

The structural change through the selective denervation is permanent. Long-term data show a lasting prolongation of the IELT. Compared to pharmacological treatments that must be taken daily or as needed, EjaNova® is a one-time solution with a permanent effect.

Can I prepare for the procedure via telemedicine?

Yes — the initial consultation, the medical history and the therapy discussion take place via video consultation. The biothesiometry and the surgical preliminary examination require an on-site appointment at the private clinic K61. The procedure itself is outpatient in the clinic.

What does the EjaNova® procedure cost?

The EjaNova® procedure is a private surgical service and is billed according to the GOÄ. The exact costs are communicated after the preliminary examination and establishment of indication in a personal conversation — they depend on the surgical effort and the clinic-specific costs. Statutory health insurance (GKV) reimbursement is generally not provided.

Take the first step now

Initial consultation — discreet, specialist, without waiting time.
The conversation is the beginning of the end of your problem.

About the author

Dr. med. Timo A. Spanholtz
Specialist in Plastic and Aesthetic Surgery - Specialist in Men's Health and Intimate Surgery

Dr. Spanholtz is the founder and chief physician of the AndroKlinik. With many years of clinical experience in men's health, andrology and reconstructive urology, he supports patients from the entire German-speaking region.

Learn more

Treatment
Premature Ejaculation

From behavioral therapy to the EjaNova® procedure

Premature ejaculation — get treatment now

All treatment options at a glance

Behavioral techniques: The first step

Start-stop technique (according to Semans)

Squeeze technique (according to Masters & Johnson)

Pharmacological therapy: Topical and systemic

Topical local anesthetics (lidocaine/prilocaine)