Topical Anesthetics for Delaying Ejaculation

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What is Premature Ejaculation?
Phosphodiesterase Type 5 Inhibitors
Class Summary
Risk factors of premature ejaculation
Further reading

Premature ejaculation is a common sexual dysfunction where an individual ejaculates earlier than they’d like during sexual activity.

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Crowdis M, Leslie SW, Nazir S. Premature Ejaculation ( [Updated 2023 Feb 7]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 9/27/2023. Guidelines on premature ejaculation (PE) have been published by the following organizations: American Urological Association (AUA) and Sexual Medicine Society of North American (SMSNA) Italian Society of Andrology and Sexual Medicine (SIAMS) The ISSM has developed evidence-based guidelines for patients suffering from lifelong PE.

Biological causes

The guidelines were most recently reviewed and revised in 2013. Discussions of the epidemiology and etiology of PE Recommended and optional questions to establish the diagnosis of PE and direct treatment Psychological/behavioral, combined medical and psychological, and educational interventions A flow chart for the management of PE The AUA/SMSNA published joint guidelines on disorders of ejaculation in 2020. Guideline statements regarding the definition of PE were as follows [61] : Lifelong PE is defined as poor ejaculatory control, associated bother, and ejaculation within about 2 minutes of initiation of penetrative sex that has been present since sexual debut. Acquired PE is defined as consistently poor ejaculatory control, associated bother, and ejaculation latency that is markedly reduced from prior sexual experience during penetrative sex. Other guideline statements on the diagnosis of PE included the following [61] : The diagnosis of PE is based on medical, relationship, and sexual history and a focused physical examination.

Surgical treatments

Validated patient-reported questionnaires may be useful in diagnosis but are not required. Laboratory testing should not be routinely used for the diagnosis of lifelong PE. Laboratory testing may be useful when clinically indicated for the diagnosis of acquired PE. Patients should be advised that circumcision status is unrelated to PE. Consider referral to a mental health professional with expertise in sexual health; patients should be advised that combination behavioral and pharmacologic therapy is more effective than either therapy alone. It can cause distress and frustration and can occur for a variety of reasons.

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Psychological contributors may include anxiety, stress, or relationship issues, while

Side Effect	Medication Type	Incidence Rate	Severity Level	Management Strategies	Notes
Nausea	SSRIs, topical anesthetics	10-15%	Mild to Moderate	Dose adjustment, timing	Usually transient
Dizziness	SSRIs, topical anesthetics	8-12%	Mild	Standing slowly, hydration	Common with beginning treatment
Headache	SSRIs, topical anesthetics	5-10%	Mild	Analgesics, time to adjust	Typically diminishes over time
Reduced Sensation	Topical anesthetics	10-20%	Mild	Reduced dose, application timing	Can affect partner satisfaction

physical factors can range from hormonal imbalances to certain neurological conditions.

Product Name	Active Ingredient	Application Method	Onset of Action	Duration	Potential Side Effects	Regulation	Effectiveness Rate	Price Range (USD)
EMLA Cream	Lidocaine, Prilocaine	Apply to glans penis	10-15 minutes	30-60 min	Numbness, irritation	OTC	70-80%	10-20
Promescent	Lidocaine-based spray	Sprayed before sex	Immediate	15-30 min	Reduced sensation	OTC	75-85%	20-30
Plexus Neo	Lidocaine patch	Applied to penis	10-20 min	Up to 1 hour	Local irritation	Prescription	60-75%	15-25

There are simple ways to treat premature ejaculation and medical intervention can provide individuals with tailored strategies that help solve the issue.

Topical anesthetic creams temporarily desensitize the penis to delay ejaculation.
SSRI medications like paroxetine are prescribed off-label for premature ejaculation.
Dapoxetine is a short-acting SSRI specifically approved for PE treatment.
Tramadol, an opioid, can help delay ejaculation but carries dependency risks.
Topical sprays offer quick, localized numbing effects to control ejaculation timing.
PDE5 inhibitors like sildenafil may improve performance in men with PE and ED.
Behavioral therapies include the stop-start and squeeze techniques to extend duration.
Kegel exercises strengthen pelvic muscles, potentially delaying ejaculation.
Counseling and sex therapy can address psychological causes of PE.
Combining medication with behavioral techniques enhances treatment effectiveness.
Herbal supplements lack robust clinical evidence but are used by some for PE.
Consultation with a healthcare provider is essential to tailor appropriate therapy.

Treatment for premature ejaculation often involves a combination of techniques.

What is Premature Ejaculation?

They include psychological approaches, behavioral techniques to control ejaculation during sex, condom use, topical anesthetics applied directly to the penis, and oral medications. Many men combine 2 or more of these therapies for the best all-around treatment. For the time being, we’ll focus on the 2 most common types of premature ejaculation pills available by prescription, SSRIs and PDE5 inhibitors. Certain prescription meds that can help delay ejaculation are prescribed off-label as premature ejaculation pills. There are 2 main classes of oral premature ejaculation medicine available by prescription: antidepressants, especially SSRIs, and PDE5 inhibitors.

Relevant Resources to Consult on Treatment for Premature Ejaculation

Though these oral meds are currently prescribed as a treatment for premature ejaculation, the FDA hasn’t approved any oral medication specifically for PE. As a result, any premature ejaculation pills you’re prescribed are being used off-label. Certain antidepressants have the side effect of delaying orgasm. Since the chemical serotonin can help delay ejaculation, antidepressants that increase serotonin levels in your brain may be used to treat PE. This class of antidepressants is called selective serotonin reuptake inhibitors (SSRIs).

Treatment Options For Premature Ejaculation

Sertraline is a common SSRI that may be prescribed off-label as a PE treatment. Research shows that this med often works well, whether it’s used daily or on an as-needed basis. Take this medication as your doctor prescribes it, either each day or as needed before sexual intercourse. When used daily, this med takes 5-10 days to start working, and it will be 2-3 weeks before you see its full effects. Oral ED drugs are part of a class of medications known as phosphodiesterase-5 (PDE-5) inhibitors. Behavioural strategies like the stop-start or squeeze techniques can be helpful.

Phosphodiesterase Type 5 Inhibitors

4.6* from over 33,000 people like you. You’ll be assessed by our UK-based clinicians via a simple online consultation. Your medication will be delivered swiftly in unmarked packaging. Repeat prescriptions keep you topped up, and you can switch any time if you wish to try alternative treatments. We’re with you throughout your journey. Medications such as selective serotonin reuptake inhibitors (SSRIs) or topical anaesthetics may be prescribed.

Class Summary

In patients with concomitant PE and erectile dysfunction (ED), the ED should be treated according to AUA guidelines on erectile dysfunction. First-line pharmacologic treatments include daily selective serotonin reuptake inhibitor (SSRI) use, on-demand clomipramine or dapoxetine (where available), and topical penile anesthetics. If first-line pharmacotherapy fails, consider on-demand dosing of tramadol or, possibly, alpha-1 adrenergic receptor blockers. Patients should be advised that there is insufficient evidence to support the use of alternative therapies (eg, intracavernous self-injection, duloxetine, venlafaxine, herbal therapies, acupuncture, botulinum toxin, modafanil, oxytocin antagonists). Patients should be advised that surgical treatments (eg, selective dorsal nerve neurotomy, pulsed radiofrequency ablation of dorsal penile nerves, hyaluronic acid gel glans penis augmentation) are considered experimental and should only be delivered as part of a clinical trial.

Basic questions to ask your doctor

The SIAMS issued guidelines on the management of PE in 2020. [22] In addition to recommendations regarding definitions and diagnosis, SIAMS recommends use of the following medications, which are approved in Europe for treatment of PE: Dapoxetine as first-line on-demand oral therapy for both lifelong and acquired PE; the suggested starting dose is 30 mg, taken with a full glass of water 1–3 h before intercourse, with no titration to 60 mg or addition of other treatment until after at least 6–8 full sexual attempts in a congruous erotic environment Eutectic lidocaine/prilocaine spray as local therapy for lifelong PE SIAMS recommendations regarding off-label therapy include the following: Obtain written and signed informed consent before initiating off-label treatment. Use dapoxetine and a tadalista tablets phosphodiesterase type 5 (PDE5) inhibitor to improve ejaculatory control in patients with comorbid erectile dysfunction (ED) and PE (loss of control of erection and ejaculation [LCEE]). Consider the combination of dapoxetine and lidocaine/prilocaine in patients with PE refractory to a single therapy. Use a PDE5 inhibitor in patients with ED or subclinical ED and PE (LCEE).

PDE5 Inhibitors for Premature Ejaculation

Consider on-demand use of an SSRI (paroxetine or fluoxetine) for PE refractory to first-line treatments and in the absence of psychiatric contraindications, as confirmed by a psychiatric consultation and psychometry. Consider daily use of clomipramine or an SSRI (paroxetine or fluoxetine) for PE refractory to first line-treatments or to on-demand SSRI use, in the absence of psychiatric contraindications, as confirmed by a psychiatric consultation and psychometry. Prescription of an antidepressant without a careful screening for depression and determination of the endogenous or reactive nature of the depression Use of alpha-1 adrenergic receptor blockers as second-line therapy in men with PE/lower urinary tract symptoms (LUTS) How does treatment for premature ejaculation work? All treatments focus on the same thing: how to delay ejaculation. There are several treatments available that work well for PE, especially when used in combination. Counselling or therapy can also be beneficial when psychological factors are involved.

Risk factors of premature ejaculation

You can access your medical team sexual enhancement pills whenever you need to, via phone and email. How we make it possible for you to have longer-lasting sex. Innovative methods of delaying ejaculation enable longer-lasting sex without compromising on pleasure. Some treatments delay premature ejaculation by boosting serotonin levels in the body, and others work by gently reducing sensitivity in the penis. Treatments for premature ejaculation can take as little as 10 seconds to start working, and usually last long enough for satisfying sex. Specialists in medicine, nutrition, performance, and diagnostics.

Dapoxetine is effective when taken 1-3 hours before intercourse.
Topical anesthetics can reduce sensation but risk partner numbness.
SSRIs may take several weeks to reach full efficacy for PE.
Tramadol's use for PE is off-label; consult a doctor before use.
Combining medication with therapy can optimize outcomes.
Avoiding excessive alcohol and stress can improve sexual performance.
Pelvic exercises increase muscle strength and ejaculatory control.
Psychological support can address anxiety-related PE.
Devices like constriction rings may be used as mechanical aids.
Open communication with partner improves treatment success.
Regular follow-up with healthcare provider is recommended.
Natural remedies lack solid clinical proof but are popular.

BSc (Hons) MBBS MRCGP AFHEA MA (Hons) AFMCP I occasionally experienced premature ejaculation during sex. Not every time, but enough that it became something that was weighing on my mind whenever I got intimate with a girl.