In the UK, EMLA cream is mostly known and used as a topical anaesthetic which is applied to the skin before needle insertion or surgical procedures on the surface of the skin. In today’s post, I will review the use of EMLA cream for premature ejaculation (PE). Summary of the post:
- What is premature ejaculation and what is EMLA cream
- Legal status of EMLA cream
- How to get EMLA cream for PE
- How much does EMLA cost?
- Review of the effectiveness of EMLA cream for PE
- How to use EMLA cream for premature ejaculation?
- Possible Side effects associated with the use of EMLA cream
What is premature ejaculation (PE)?
Premature ejaculation is a common sexual dysfunction affecting men characterised by ‘brief ejaculatory latency‘ (ejaculation happens too quickly) or loss of control of ejaculation. Although there are many definitions of PE provided by different healthcare organisations an bodies, the key components of each definition include (Mohee & Eardley, 2011):
- A short ejaculation latency (time taken for the man to ejaculate)
- Loss of control of ejaculation
- Loss of sexual satisfaction
PE can be a result of different factors including stress, depression, sex anxiety and accompanying conditions. Men who experience symptoms of premature ejaculation can see their GP and talk about the potential treatment of their condition.
Premature ejaculation: recommended treatment in the UK
A detailed treatment of premature ejaculation will be covered in a separate post. In a nutshell, NICE recommends the following treatment for premature ejaculation (NICE, 2020):
- Non-drug treatment (for example education and psychological counselling) used alone or in combination with a drug treatment
- Dapoxetine (brand name: Priligy), a short-acting selective serotonin reuptake inhibitor is a licensed medication for the management of PE
- Other selective serotonin reuptake inhibitors (used in the treatment of depression) can be used as unlicensed medicines to treat PE (for example fluoxetine, citalopram, sertraline and others)
- Tricyclic antidepressants (unlicensed use) such as clomipramine
What is EMLA cream?
EMLA 5% cream contains two active ingredients: Lidocaine 2.5% and Prilocaine 2.5%.
Both ingredients belong to a group of drugs called a local anaesthetic. EMLA cream helps with the management of PE by reducing the sensitivity of the penis and therefore delay ejaculation. Reduced sensitivity by both lidocaine and prilocaine is achieved through the block of pain receptors located in nerve endings.
EMLA cream for premature ejaculation legal status
In the UK, EMLA cream has a legal status of pharmacy-only ‘P’ medication. ‘P’ drugs can only be sold from registered pharmacies, including online chemists.
All drugs which are sold from a pharmacy should be supplied according to the product license. EMLA cream, which is available for the public to buy, is licensed as a topical medication to provide local anaesthesia of the skin (skin numbing cream). EMLA used for premature ejaculation is currently prescribed as an unlicensed product. Doctors in the UK can prescribe unlicensed drugs in the treatment of different conditions. Specific rules apply to drugs prescribed outside their license, for example, where possible a licensed product should be used in the first place.
How to get EMLA cream for premature ejaculation?
When used for premature ejaculation, EMLA cream needs to be prescribed by a doctor. This requirement comes from the fact that at this moment, EMLA cream is used as an unlicensed medication.
Currently, EMLA can be purchased for the treatment of premature ejaculation trough variety of online services. Pharmacies such as Lloyds Pharmacy and Superdrug offer EMLA cream as a part of private online services. A patient who wishes to purchase EMLA for premature ejaculation needs to complete a questionnaire about their health and pay for the order. A doctor then reviews a questionnaire. Once approved, EMLA cream is sent by post. Consultation and ‘private prescription’ fees are included in the price of the product to simplify the process.
How much does EMLA cost?
Prices for the supply of EMLA cream for the treatment of premature ejaculation vary between online pharmacies. You may be expected to pay for a 5g tube of EMLA cream around £12-£20. Prices usually include the cost of private prescription produced by a doctor after a questionnaire answered by a patient is screened.
Can you get EMLA cream on NHS?
Doctors can prescribe almost any drug on the NHS. Generally, it is recommended to prescribe a licensed product to treat a specific condition. Priligy (dapoxetine) is the only licensed product for the treatment of premature ejaculation. Priligy is rarely prescribed in NHS (385 prescriptions in the last 12 months (May’ 19—Apr ’20), OpenPrescribing.net, 2020)
5g tube of EMLA cream costs around £4 when purchased over the counter as a numbing cream (licensed use).
What is the cheapest option for the purchase of EMLA cream for premature ejaculation?
The cheapest option for supply EMLA cream would be with a private prescription as long as one obtained it without high, additional cost. When a private prescription is presented for an EMLA cream in a pharmacy, one would be expected to pay around £5 for a 5g tube of the cream. Please note some chain pharmacies such as Boots Pharmacy, have a minimum charge for private prescriptions, which may be higher than the price of the item.
Do I really need a prescription for EMLA?
Some of you may ask whether a prescription is needed despite EMLA being available over the counter as pharmacy only medication.
When a request is made to purchase medication in a pharmacy, patients are asked a set of ‘standard‘ questions by a member of a pharmacy team. Some common questions may include the description of symptoms present to confirm the suitability of the medication being requested. Patients who make a request for EMLA for treatment of premature ejaculation will most likely be refused the sale by a pharmacist, as EMLA is not licensed for this condition at this time.
Review of the effectiveness of EMLA cream for PE
One study looked at all evidence from available clinical trials which exists around the use of topical anaesthetics such as EMLA cream for premature ejaculation. This process is called a systemic review and meta-analysis. The purpose of this study was to evaluate the evidence from clinical trials and to compare the effectiveness of treatment available for PE.
In relation to the effectiveness, the main factor that was reviewed was intravaginal ejaculation latency time (IELT). IELT is the time taken for the man to ejaculate when having sex. There was a significant difference when EMLA cream was compared to placebo ( a dummy product) in IELTs results. The combined average difference for IELT between EMLA cream and placebo product was 6.44 mins (the time it took to ejaculate), notably increasing time in men with premature ejaculation.
How to use EMLA cream for premature ejaculation?
When used for premature ejaculation EMLA cream is usually applied 15 to 30 minutes before sex. EMLA should be applied to the penis. Patients need to leave the cream for longer when more cream is applied to the penis. This also means that the sensitivity of the pencils will be reduced more. A pea-size amount (approximately 1g of cream) should be sufficient to cover the area of the penis head.
Any excess of EMLA cream should be wiped off before having sex to reduce the possibility of partner’s desensitisation and reduce the risk of the condom splitting. EMLA cream is oil-based. NHS suggests that oil-based products can damage latex increasing the risk of condom splitting (NHS, 2017). Alternatively, men can use two condoms or use polyurethane condoms, which are safe to use or consider alternative options for contraception.
Side effects possible with EMLA cream
EMLA cream is generally well tolerated; however, some patients may experience side effects. Common side effects associated with the use of EMLA cream are usually localised and may include:
- skin warm to touch
Side effects listed above may transient and should go on their own. For more information about side-effects, please read the product information leaflet.
Available data from clinical trials indicate that EMLA cream is effective in the management of symptoms of premature ejaculation. Although EMLA cream is used as an unlicensed product for PE, it can be purchased easily online for a reasonable price (always compare a few websites).
Does EMLA cream work for premature ejaculation?
The information available from clinical trials suggest EMLA cream is effective in the management of premature evacuation, increasing ejaculatory latency time to over 6 minutes as compared to placebo (a dummy treatment).
What cream can I use to last longer in bed?
EMLA cream can be prescribed as unlicensed medication for management of premature evacuation. EMLA cream is effective and makes men last longer as confirmed by different clinical trials.
Is there a pill to stop premature ejaculation?
In the UK, Dapoxetine (Priligy) is licensed for the treatment of premature ejaculation. Other non-licensed drugs used include EMLA cream, selective serotonin reuptake inhibitors and tricyclic antidepressants.
NHS (2017). Condoms. Available at: https://www.nhs.uk/conditions/contraception/male-condoms/ Accessed on 10/07/2020
Mohee A, Eardley I. Medical therapy for premature ejaculation. Ther Adv Urol. 2011;3(5):211-222. Available at: https://dx.doi.org/10.4103%2F0970-1591.32056 Accessed on 11/07/2020
NICE (2020). Premature ejaculation: treatment. Available at https://bnf.nice.org.uk/treatment-summary/premature-ejaculation.html Accessed on 10/07/2020
OpenPrescribing.net (2020). Total prescribing for Priligy across all CCGs in NHS England. Available at: https://openprescribing.net/analyse/#org=CCG&numIds=0704060A0BB&denom=nothing&selectedTab=summary Accessed 13/07/2020