What are the causes of premature ejaculation?
Studies on premature ejaculation have found that many factors cause premature ejaculation, not a single cause. Partner, sexual intercourse position, frequency of intercourse, psychological state of the person, stress, some diseases (prostate inflammation, thyroid gland disorders, hormonal irregularities), medications, erectile dysfunction may affect the duration of ejaculation.
How is premature ejaculation treated?
Although many different treatments have been tried so far, the search for the ideal permanent treatment is still ongoing. Behavioral therapies, psychotherapy, drug therapies and other treatments (penile head filling and dorsal neurectomy) will be explained in detail in our article:
Topical anesthetics (sprays and creams): Sensory receptors on the glans penis are stimulated during intercourse. Ejaculation is controlled by a center in brain. With the stimulation of this center, the ejaculation starts. Topical anesthetics (creams and sprays) that delay stimulation on the glans penis are applied about 15 minutes before intercourse. However, before going to bed, it is necessary to clean and wipe the applied area from the cream or spray. Otherwise, your partner may also experience numbness and inability to feel.
SSRIs (selective serotonin re-uptake inhibitors): It is known that the activity of the substance called serotonin in the center that controls ejaculation in the brain is low in men with premature ejaculation. For this purpose, drugs that increase serotonin levels (SSRIs) are used in the treatment of premature ejaculation.
These drugs (SSRIs) are actually drugs used in the treatment of depression. Their ejaculation delaying effects occur after 1-2 weeks of use. However, they have side effects such as decreased sexual desire (libido), inability to ejaculate, inability to orgasm and erectile dysfunction in long-term use.
Dapoxetine: This drug is a short-acting SSRI, which means that it works by increasing serotonin levels. Unlike other drugs, there is no need for long-term use. It is enough to take 1-2 hours before intercourse. Some side effects of the drug are nausea, diarrhea, headache, dizziness, muscle aches. Due to side effects, ineffectiveness and cost, 90% of those who use Dapoxetine refuse to use the drug.
Dorsal penile neurectomy: It is a procedure to cut the nerves that provide sensation to the head of the penis. The procedure can be performed under local or general anesthesia. With a 3-4 cm incision made on the dorsal side of the penis from the circumcision line, the nerve fibers going to the head of the penis are primarily found. These nerve bundles run in 5-6 bundles on the back of the penis.
There is a membrane layer surrounding the cylindrical bodies known as corpus cavernosum, which provides erection in the penis. The nerve bundles travel over this membrane layer (tunica albuginea) and enter the glans and receive the sense of touch on the surface. This procedure is a successful method in the treatment of premature ejaculation. However, serious and permanent side effects may occur. There are different opinions about how many nerve bundles should be separated precisely and how many should be cut and how many should be left. Sensory loss in the area where the nerve bundles are cut is permanent. Inadequate nerve bundle cutting results in failure of the procedure. In addition, since the incision is made on the skin and lower layers of the penis, there are risks associated with this. For all these reasons, our patients and physicians prefer methods with fewer side effects.
Glans penis fillers:
It is based on the principle of creating a thin barrier layer with fillers called hyaluronic acid under the skin on the head of the penis (glans penis). With the formation of this barrier layer, the stimuli that will provide ejaculation during sexual intercourse are delayed and the person continues the relationship longer and ejaculates later.
Hyaluronic acid is a substance that exists in the human body and is present in the skin, subcutaneous tissue and articular cartilage. Since it holds water, it provides elasticity, vitality and fullness of the tissue. Its production decreases in the body with aging. Hyaluronic acid is widely used in facial aesthetics, joint disorders and genital aesthetics in recent years. As the skin structure of each region in our body is different, the hyaluronic acid to be used should also have a different structure. We use hyaluronic acid molecules specially developed and licensed for the tissues of the genitals and compatible with these tissues.
Who are candidates for glans fillers?
Fillers can be applied to people who have premature ejaculation problem, who have tried different treatment methods before and have not benefited, or who have benefited from medication, spray, cream treatments and do not want to use them.
Who is not eligible for glans fillers?
It is not applied to people who have an inflammation on the skin of the penis or a sexually transmitted inflammation (gonorrhea). These people become suitable candidates after the inflammation is treated.
It is also not applied to those who use anticoagulant medications (such as aspirin, ecoprin).
Is glans filler injection painful?
The procedure is performed under local anesthesia so that the patients do not feel pain. There are 2 methods for this:
1. Local anesthetic creams. The cream is applied to the glans and waited for 30 minutes.
2.Anesthetic medications applied to the circumcision line. The medicine is injected into the circumcision line in a very thin line. In the meantime, pain relief cream is applied beforehand so that patients do not feel pain. 5 minutes after the drug injection, the patient is completely ready for the procedure.
The effect of local anesthesia lasts for several hours. Very rarely, a slight local discomfort may occur afterwards.
How is the glans filler injection applied?
Filling material is applied under the skin on the glans with very thin cannulas. With my technique, the filler is distributed homogeneously and symmetrically on the glans penis. There is no abnormal deformity in the penis after the procedure. Entry is made at certain points from the upper part of the penis head.
How many minutes does glans filler injection take?
The procedure starts after local anesthesia is applied. The procedure is completed in about 10 minutes. If we take into account the preparation time, the procedure is completed in a total of 20-30 minutes.
Can I return to my daily life after glans filler injection?
Our patients can return to their daily lives after glans filler injection.
What should I pay attention to after glans?
After the glans filler procedure, an antibiotic bandage is applied to the glans. In this way, they can leave our clinic and return to their normal lives. Patients are not recommended to take a bath on the same day after the procedure. They are advised to drink plenty of water for a few days, not to go the sauna or hammam, and not to wear very tight underwear.
How many days after penile head filling application can sexual intercourse be started?
Sexual intercourse can be started 1 week after the application of filler on the glans penis. Using a condom is not recommended as it will cause pressure on the glans penis.
How long does the effect of penile head filling last? Is the effect permanent?
It is known that permanent fillers have harmful effects on the tissue and the whole body. Hyaluronic acid fillers consist of molecules that exist in the body. They break down over time and disappear without harming the body. This period may vary from person to person or depending on the filler used. In general, it has a permanence between 6-12 months.
When does the effect of penis head filling appear?
We recommend sexual abstinence for 1 week after applying penile head filler. After this period, our patients can start intercourse. However, the effect of the filling may not be observed immediately due to the break in intercourse. The best results will usually appear after 1 month of regular intercourse.
Can the glans filler be reapplied?
Hyaluronic acid fillers applied to the glans are broken down in the body and destroyed over time. For this reason, the procedure can be repeated in patients where the effectiveness of the treatment decreases. There is no harm in repeating it.
Is the type and brand of filler used for glans penis important?
The structure of the penis body or glans differs from other parts of the body. For example, there is no fat layer under the skin of the penis and there are vascular and nerve-rich tissues under the skin that provide hardening. The glans penis also has a very thin skin with a nerve layer underneath for sensation and vascular-rich spongy tissues underneath.
Some fillers with a longer lasting effect have been shown to cause vascular pressure or occlusion the glans penis and cause permanent damage to the penis. For this reason, the most ideal filler to be applied for the glans penis is hyaluronic acid.
Not every hyaluronic acid filler may be compatible with penile tissue. Many features such as molecule size, cross-linking of molecules, viscosity should be taken into consideration when choosing a hyaluronic acid filler suitable for the tissue. The filler used for the chin, eyes, lips or nose may not be suitable for the penis shaft and glans. In our clinic, we use a filler brand specially developed and patented for the penis and the head of the penis.
Does penile head filling cause loss of sensation and erectile dysfunction?
The purpose of glans filler application is to create a barrier on the nerve layer and slow down the sensory transmission. There is no loss of sensation in the penis. Likewise, it does not cause any damage to the cylindrical structures (corpus cavernosum) that provide erection in the penis. For this reason, there is no erectile dysfunction.
How long does glans filler extend the duration of intercourse?
Different results have been reported in studies published so far on glans filler application. In the most scientifically powerful study, it was reported that 67% of patients achieved a 2.6-fold increase in intercourse duration in the 1st month after the procedure. When other studies are taken into consideration, it is seen that an average of 60% of patients achieved a 2-3-fold increase in intercourse duration.