EMLA cream

EMLA cream is a numbing cream, also known as a topical anaesthetic, which is used to treat premature ejaculation (PE). EMLA cream is a brand name of prilocaine and lidocaine, which are the 2 active ingredients.

EMLA cream is used for PE as an ‘off-license’ medicine. This means it was not made for PE, but it can be prescribed by your doctor for this, if suitable.

EMLA cream works by reducing the sensitivity of the penis, helping you to last longer and delay ejaculation.

EMLA cream contains the 2 active ingredients, lidocaine and prilocaine. These are local anaesthetics that work by reducing sensitivity in the area to which it is applied.

How long does EMLA cream last?

EMLA cream’s numbing effect normally lasts for at least 2 hours.

How long does it take for EMLA cream to work?

EMLA cream works relatively quickly. Most people who use the cream will start to feel its numbing effects within 15 to 30 minutes. You should apply it at least 15 minutes before sex.

How effective is EMLA cream?

Several studies have shown EMLA cream to be an effective treatment for PE. One study found that applying EMLA cream was effective in 77.3% of men.

The optimum time of application of EMLA cream in studies is 20 minutes before sex, with the optimum concentration being 5%.

To use EMLA cream, follow these steps:

1. Wash your hands thoroughly.
2. Apply a pea sized amount of EMLA cream to the shaft and the head of the penis (glans) roughly 15 to 20 minutes before sex. You do not need to rub the cream in, just put a layer of it onto the penis.
3. Wash your hands thoroughly after application to prevent the cream from affecting your hands.
4. You can leave it for up to 60 minutes if you do not notice any reduced sensation.
5. Wash off the cream from your penis before you have sex. This will stop the cream from affecting your partner.

If you do not feel the cream is working, you can apply it to a slightly wider area. Your doctor can give you personalised advice about how to apply the cream for PE.

When using EMLA cream, you should avoid:

• using it on an open wound (sore or cut)
• using large amounts or over a large area of skin – too much anaesthetic could be absorbed into your blood, which could be dangerous
• it coming into contact with your eyes

If you get EMLA cream in your eyes, this can cause a corneal abrasion, which is a superficial scratch at the front of your eye (cornea). If this happens, you must wash your eyes right away with a saline solution and call 111 or your GP.

As with any medication, EMLA cream may cause side effects. However, these side effects normally go away quickly once you have removed the cream.

Common side effects of EMLA cream include:

• redness
• swelling
• burning sensation
• itchiness
• warmth
• paleness

Uncommon side effects of EMLA cream include:

• numbness (tingling)
• irritation of the treated skin (if used for leg ulcers)

Although rare, there is the possibility of having an allergic reaction to EMLA cream. If you notice the following symptoms, these can be signs of a severe allergic reaction and you must visit A&E right away or call 999:

• drowsiness
• facial swelling
• shortness of breath

These are not all the side effects of EMLA cream. For a full list, you should read the patient information leaflet inside your medication packet.

You should not use EMLA cream if you are allergic to prilocaine or lidocaine, other similar local anaesthetics, or if you have an open wound on your penis.

Speak with your doctor or pharmacist before you use EMLA cream if you have:

• a rare inherited condition which affects the blood (glucose-6-phosphate dehydrogenase deficiency)
• a red blood cell disorder (methemoglobinemia)
• certain itchy skin conditions, such as atopic dermatitis
• anaemia

Let your doctor or pharmacist know if you are currently taking or plan to take other medications, including those that are prescribed, over-the-counter, or herbal, while using EMLA cream. This is because EMLA cream may affect how some medications work, and certain medications may have an effect on EMLA cream.

Speak to your doctor or pharmacist if you have been given:

• medication used to treat epilepsy, like phenobarbital and phenytoin
• medication used to treat infections, like nitrofurantoin and sulphonamides
• medication used to treat an irregular heartbeat, like amiodarone
• beta-blockers or cimetidine
• other local anaesthetics

EMLA cream comes in a 5g tube. Each gram of EMLA cream contains 25mg of prilocaine and 25mg of lidocaine. Other ingredients in EMLA cream include:

• sodium purified
• macrogolglycerol hydroxystearate
• carbomer 974P
• water purified

As well as EMLA cream, another common treatment used to treat premature ejaculation is Priligy. This medication is taken in tablet form and should be used 60 minutes to 3 hours before you have sex. Priligy can delay ejaculation for up to 12 hours after you take a dose.

Both EMLA cream and Priligy work to delay ejaculation, though they work in different ways. You may find EMLA more suitable if you would prefer a more localised treatment for premature ejaculation. It is also conveniently available over the counter.

If your partner is allergic to lidocaine or prilocaine, the active ingredients in EMLA, Priligy may be a more suitable alternative because your partner will be exposed to the cream as well as you. Similarly, if you are currently on selective serotonin reuptake inhibitors (SSRI) medications for mood-based treatment, tell your doctor as Priligy would not be a suitable option.

Here is an overview of the differences between them:

Sometimes other factors like confidence, anxiety, or depression can get in the way of sex – this is completely normal. You might feel as though you are anxious to perform in bed, or you might be having trouble in your relationship. In this case, you should communicate with your partner. You can also have behavioural and psychological therapy, which are non-drug treatments for premature ejaculation. Speak to your doctor or pharmacist for more information on psychological therapy.

Lifestyle changes for premature ejaculation

Physical factors can affect your sex life in the same way that psychological factors might. So, making small lifestyle changes may also help you manage premature ejaculation.

We recommend changes such as:

Stopping smoking

A study has found that smoking can sometimes contribute to premature ejaculation. This is because smoking creates changes in the blood flow and hormones, disrupting the process of ejaculation. Stopping smoking can improve this.

Diet

There is limited medical research on the relationship between diet and premature ejaculation, though some clinical studies have found that deficiencies in certain vitamins are linked to worsening cases of PE. In particular, low levels of vitamin D, which is found in sunlight, milk, eggs, and oily fish like salmon and sardines.

Other studies have found that low levels of folic acid (found in dark green leafy vegetables, legumes, citrus fruits, and nuts) can also contribute to the development of PE.

Adjusting your diet alongside medication may improve premature ejaculation. We recommend reducing your intake of:

• sugary foods and drinks (fizzy drinks and chocolate)
• excessive saturated and trans fats (fried foods, crisps, cakes, pies, and pastries)

Alcohol

Alcohol can affect sexual function, with 72% of alcohol dependent men experiencing sexual dysfunction, the most common being premature ejaculation. So, cutting down your alcohol intake may improve premature ejaculation.

Regular exercise

Regular, light exercise can help with premature ejaculation and ejaculation control. Clinical studies have found regular exercise as a potential way to treat premature ejaculation, alongside medication, including:

• yoga
• running
• swimming

You can also try targeted exercises, which can strengthen your pelvic floor muscles, such as Kegel exercises.

Weight loss

Weight loss has been clinically found to significantly improve premature ejaculation. There is a range of weight loss treatments available, which include lifestyle changes or weight loss medications.

If you’re unsure if your weight is causing or worsening your premature ejaculation, you should speak to your doctor. You can also check your body mass index (BMI) with our BMI calculator, where you can also find out what a healthy BMI is.

Making lifestyle changes is also complementary to treatments like EMLA. If you have any specific questions about lifestyle changes that may be more suitable for you to make, speak to your doctor, and they should be able to provide you with personalised advice.