The evolution of clinical guidelines for premature ejaculation (PE) reflects ongoing efforts to integrate emerging evidence and refine therapeutic approaches. The International Society for Sexual Medicine (ISSM) guidelines have historically emphasized selective serotonin reuptake inhibitors (SSRIs) and topical anesthetics as first-line therapies while explicitly excluding surgical interventions. Since the 2010 ISSM guidelines, the objective has been to provide concise, evidence-based recommendations applicable to both family practitioners and sexual medicine specialists. Despite updated definitions and expanded treatment options, controversy persists. Many patients continue to experience unsatisfactory outcomes, and clinicians often express frustration with the limited scope of current guidelines. Notably, in several Asian countries, the use of surgical approaches—including selective dorsal neurectomy (SDN) and glans penis augmentation (GPA) with hyaluronic acid (HA)—has increased, particularly after the introduction of dapoxetine. This trend underscores the demand for alternatives in cases refractory to pharmacotherapy. A landmark development occurred in 2024 when the ISSM guidelines formally acknowledged GPA with HA as an optional intervention for lifelong or acquired PE within specialized centers. This paradigm shift reflects growing recognition of GPA’s safety profile, reversibility, and patient-centered advantages, positioning it as a contemporary complement to pharmacological management in select cases.