Are topical treatments for premature ejaculation (PE) effective? A recent Sexual Medicine Reviews paper considered this question.
PE occurs when a man feels he has little ejaculatory control and ejaculates before he wishes it to happen. The condition can be distressing for some men and particularly bothersome for couples.
PE is often described in terms of intravaginal ejaculation latency time (IELT) – the time between vaginal penetration and ejaculation. According to ISSM guidelines, men with lifelong PE typically have an IELT of less than one minute, and they have struggled with the situation since their first sexual intercourse. Men with acquired PE generally have an IELT of less than three minutes. Acquired PE occurs after having satisfactory ejaculatory control in the past.
Men with PE feel significantly distressed about their situation and may feel depressed or anxious as well.
Topical treatments have been developed to treat PE, but research has been limited. For this paper, the research team reviewed published medical studies and considered clinical experience on six types of treatments.
They shared the following findings:
Eutectic Mixture of Local Anesthetics (EMLA)
This cream contains lidocaine 2.5% and prilocaine 2.5%. Studies instructed participants to apply the cream to the penis about 20 to 30 minutes before sexual activity. In one study of 11 participants, 82% of the men had improvements in their PE symptoms. In another study, men who used the EMLA cream had a 5.6-fold increase in IELT. Side effects included numbness and irritation. Experts recommend that men who use EMLA use condoms or wash off the cream before sex to avoid transferring it to a partner.
Eutectic Lidocaine and Prilocaine Spray (PSD502)
PSD502 is a metered-dose spray developed under two names: TEMPE and Fortacin. TEMPE combines lidocaine 7.5 mg and prilocaine 2.5 mg. The substance “allows for more targeted drug delivery” because it can penetrate “poorly-keratinized areas of the penis.” One study found a 6.3-fold increase in IELT in men using the drug compared to a 1.7-fold increase for men using a placebo.
Severance Secret Cream
This cream contains nine natural products (e.g., ginsenoside, eugenol, bufosteroid, and methyl leugenol) and acts as a local anesthetic. One trial found that men who used the cream developed a higher penile sensory threshold. Another pair of studies reported an 80% efficacy rate for men with PE. The majority of partners were satisfied.
RTX is derived from cactus plants and has been used to treat overactive bladder and interstitial cystitis. In one study, men were instructed to soak their penis in a prepared solution for 30 minutes. IELT results were greater for uncircumcised men compared to circumcised men and those in placebo groups.
“No controlled studies indicate the efficacy or safety of these products,” the authors wrote.
Research on medicated condoms has been limited. Online forum members reported that the condoms, which contain variations of benzocaine, were well-tolerated and worked rapidly. Some described numbness, weaker erections, and dermatitis.
Overall, clinical trials of topical treatments “demonstrate increases in timed intravaginal ejaculatory latency time and improved patient-partner satisfaction,” the authors wrote. They recommended further research on cost-effectiveness, side effects, and efficacy. More study on psychological treatments for PE was also encouraged.
Sexual Medicine Reviews published the study online in April as an article in press.
Sexual Medicine Reviews
Butcher, Michael J., DO, et al.
“Topical Agents for Premature Ejaculation: A Review”
(Full-text. Article in press. Published online: April 12, 2019)