https://doi.org/10.4081/aiua.2026.14899
The effect of glandular frenulectomy on refractory lifelong premature ejaculation: a pilot study
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 22 June 2026
Purpose: Premature ejaculation (PE) is one of the most common male sexual disorders and is influenced by both psychological and biological factors. Despite available treatments, including psychosexual therapy and pharmacological interventions, no definitive cure exists. In addition, various interventional approaches have been investigated for lifelong PE, such as glandular filler injections, partial dorsal nerve neurectomy, and frenulectomy.
Patients and Methods: This pilot study evaluated the effect of glandular frenulectomy in 25 married men with lifelong PE who had not responded to conventional treatments for at least six months. Participants underwent glandular frenulectomy and were assessed before surgery and three months postoperatively using Intravaginal Ejaculatory Latency Time (IELT) and the Arabic Index of Premature Ejaculation (AIPE) scores.
Results: No statistically significant improvement was observed in IELT or AIPE scores after surgery. The mean IELT and AIPE scores before and three months postoperatively yielded P-values of 0.058 and 0.090, respectively.
Conclusion: In this pilot study, glandular frenulectomy did not result in significant short-term improvement in men with lifelong PE unresponsive to conventional therapy. Larger studies with longer follow-up are needed to further evaluate its therapeutic role.
Downloads
1. Saitz TR, Serefoglu EC. Advances in understanding and treating premature ejaculation. Nat Rev Urol. 2015; 12:629-40.
2. Saitz TR, Serefoglu EC. The epidemiology of premature ejaculation. Transl Androl Urol. 2016; 5:409-15.
3. Althof SE, McMahon CG, Waldinger MD, et al. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med. 2014; 2:60-90.
4. Raveendran AV, Agarwal A. Premature ejaculation - current concepts in the management: A narrative review. Int J Reprod Biomed. 2021; 19:5-22.
5. Gillman N, Gillman M. Premature Ejaculation: Aetiology and Treatment Strategies. Med Sci (Basel). 2019; 7:102.
6. Martin C, Nolen H, Podolnick J, Wang R. Current and emerging therapies in premature ejaculation: Where we are coming from, where we are going. Int J Urol. 2017; 24:40-50.
7. Hu QB, Zhang D, Ma L, et al. Progresses in pharmaceutical and surgical management of premature ejaculation. Chin Med J (Engl). 2019; 132:2362-2372.
8. Arafa M, Shamloul R. Development and evaluation of the Arabic Index of Premature Ejaculation (AIPE). J Sex Med. 2007; 4:1750-6.
9. Revicki D, Howard K, Hanlon J, et al. Characterizing the burden of premature ejaculation from a patient and partner perspective: a multi-country qualitative analysis. Health Qual Life Outcomes. 2008; 6:33.
10. Hanafy S, Hamed AM, Hilmy Samy MS. Prevalence of premature ejaculation and its impact on the quality of life: Results from a sample of Egyptian patients. Andrologia. 2019; 51:e13298.
11. Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010; 57:804-14.
12. El-Hamd MA, Saleh R, Majzoub A. Premature ejaculation: an update on definition and pathophysiology. Asian J Androl. 2019;21:425-432.
13. Halata Z, Munger BL. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res. 1986; 371:205-30.
14. Gallo L, Perdonà S, Gallo A. The role of short frenulum and the effects of frenulectomy on premature ejaculation. J Sex Med. 2010;7:1269-76.
15. McMahon CG. Current and Emerging Treatments for Premature Ejaculation. Sex Med Rev. 2015; 3:183-202.
16. Perelman MA. A new combination treatment for premature ejaculation: a sex therapist's perspective. J Sex Med. 2006; 3:1004-1012.
17. Ciocca G, Limoncin E, Mollaioli D, et al. Integrating psychotherapy and pharmacotherapy in the treatment of premature ejaculation. Arab J Urol. 2013; 11:305-12.
18. Abdallah H, Abdelnasser T, Hosny H, et al. Treatment of premature ejaculation by glans penis augmentation using hyaluronic acid gel: a pilot study. Andrologia. 2012; 44 Suppl 1:650-3.
19. Littara A, Palmieri B, Rottigni V, Iannitti T. A clinical study to assess the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. Int J Impot Res. 2013; 25:117-20.
20. Sun S, Han L, Li Y, et al. The safety and efficacy of dorsal penile nerve block for premature ejaculation: A systematic review and meta-analysis. Medicine (Baltimore). 2019; 98:e16479.
21. Yang CC, Bradley WE. Innervation of the human glans penis. J Urol. 1999; 161:97-102.
Ethics Approval
CRediT authorship contribution
MFR, study concept, design, and supervision; YIEK, methodology, data interpretation, and contribution to manuscript writing; OASED, data collection and manuscript original drafting; FLAA, clinical examination and data curation; AHTK, statistical analyses and literature review; MAA, manuscript critical revision and editing. All the authors read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work
Data Availability Statement
The datasets used and/or analyzed during the current study are available upon reasonable request from the corresponding author
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.