Emla® Cream

Emla® Cream contains the two local anesthetics lidocaine and prilocaine and is used for local numbing of the skin. For premature ejaculation (ejaculatio praecox), it is applied off-label to the glans to reduce sensitivity and prolong the time until ejaculation.

Premature ejaculation is the most common sexual dysfunction in men and affects about 20–30% of all men. Topical desensitization with Emla® is an established method that has significantly prolonged the intravaginal ejaculatory latency time (IELT) in several studies.

Mechanism of action:

• Lidocaine and prilocaine block sodium channels in the nerve fibers
• Prevent the transmission of nerve impulses
• Reduce the sensitivity of the glans (glans penis)
• Prolong the time until ejaculation

Clinical effect:

• Reduction of hypersensitivity of the glans
• Prolongation of the IELT (intravaginal ejaculatory latency time) by 2–5 times
• Onset of action: 15–20 minutes after application
• Duration of action: 30–60 minutes

Evidence: Several randomized studies show a significant prolongation of the IELT with topical anesthetics.

Emla® Cream for premature ejaculation is suitable for:

• Men with premature ejaculation (lifelong or acquired)
• Especially when penile hypersensitivity is the cause
• As an alternative or supplement to dapoxetine (Priligy®)

Advantages:

• Used only when needed
• Acts locally
• Effect after a contact time of 15 minutes (no dosing cycle required)

Not suitable:

• Allergy to lidocaine, prilocaine, or amide local anesthetics
• In case of open wounds or inflamed skin
• Note: May impair the female partner's sensation (use a condom!)

Premature ejaculation (off-label):

• Apply a small amount (approx. 1–2 g) to the glans
• 15–20 minutes before sexual intercourse
• After the contact time, wash off thoroughly or use a condom

General use (skin anesthesia):

• Thick layer on the skin, cover with an occlusive dressing
• Contact time: 1–5 hours (depending on the indication)

Important: The amount needed for premature ejaculation is significantly smaller than for skin anesthesia.

Use for premature ejaculation: 1. Apply a small amount of Emla® to the glans (approx. 1–2 g) 2. Spread evenly, especially on the frenulum and the corona of the glans 3. Leave on for 15–20 minutes 4. Wash off thoroughly with warm water BEFORE sexual intercourse 5. OR put on a condom (prevents transfer to the female partner)

Important notes:

• Be sure to wash it off or use a condom before contact! Otherwise the female partner will be numbed as well.
• Do not overdose (too much can impair erection)
• Start with a small amount, increase if needed
• Do not apply to damaged genital mucosa

Emla® must not be used in cases of:

• Allergy to lidocaine, prilocaine, or other amide local anesthetics

Caution in cases of:

• Atopic dermatitis (increased absorption)
• G6PD deficiency (risk of methemoglobinemia)
• Hereditary or idiopathic methemoglobinemia
• Concomitant use of medications that induce methemoglobinemia
• Use over large areas

Common (1–10%):

• Temporary burning/stinging during application
• Redness of the skin
• Paleness at the application site
• Mild edema

Uncommon:

• Itching
• Local allergic reaction
• Numbness (intended, but may be too strong)

Rare:

• Methemoglobinemia (with massive overdose)
• Systemic reactions (only with use over large areas)

Note: With the small amount used for premature ejaculation, systemic side effects are practically ruled out.