Topical Sprays and Creams for Premature Ejaculation
Psychogenic causes include anxiety, an unpleasant introductory or early sexual experience, infrequent sexual intercourse, poor ejaculatory control techniques, and evolutionary as well as psychodynamic factors. Urologic causes, including chronic prostatitis, have also been implicated [14]. Early animal studies revealed that nonselective agonists of the 5-HT2C receptors delay ejaculation, but selective 5-HT2A agonists do not have a similar effect, and selective 5-HT1A agonists cause a shorter ejaculatory latency compared with 5-HT2C agonists [15,16]. hypothesized that PE may be secondary to relative hyposensitivity of the 5-HT2C and/or 5-HT1A hypersensitivity [17]. The effect of postsynaptic 5-HT receptor activation on delayed ejaculation was later confirmed by using different selective serotonin reuptake inhibitors (SSRIs) [18–22]. The possible influence of genetic causes was investigated in a survey of 1,196 men in Finland that suggested the presence of a familial or genetic influence in 28% of men [23]. Decreasing sensory perception in the penis has been the goal of most topical agents aimed at treating PE. As a general rule, reliable controlled studies have been lacking in this area.
| Brand Name | Active Ingredient | Duration of Effect | Typical Dose | Side Effects | Price Range ($) |
|---|---|---|---|---|---|
| Fortacin | Lidocaine | 30-60 minutes | 2 sprays per use | Numbness, irritation | 15-25 |
| Emla Cream | Lidocaine & Prilocaine | 30-45 minutes | Apply 10-15 mins before | Loss of sensation | 10-20 |
| Dapoxetine (Priligy) | Dapoxetine | 1-3 hours | 30 mg as needed | Dizziness, nausea | 1.5-2.5 per pill |
| Super Ejaculation | Tramadol (off-label) | 2-4 hours | 50 mg | Drowsiness, constipation | 12-18 |
| Amlodipine | Amlodipine (off-label) | Varies | 5-10 mg daily | Swelling, fatigue | 5-12 |
Penile biothesiometry studies have shown that patients with PE have increased penile sensitivity as shown by consistently decreased vibratory threshold that is not age dependent [24,25]. Lidocaine- or prilocaine-based sprays, creams, or gels, as well as eutectic (i.e., melts easily) mixtures, have shown promise [26,27]. Their application offers a rapid onset of effect, with relatively mild numbness. A typically mild adverse side effects profile and availability for on-demand usage are other advantages in this category. In 9 of 11 men with PE, prilocaine-lidocaine cream (EMLA [eutectic mixture of local anesthetics], Astra Pharmaceuticals, Wayne, PA, USA) was shown to markedly improve IELT without any reported adverse events [28].
Premature Ejaculation Risk Factors
Their application offers a rapid onset of effect, with relatively mild numbness. A typically mild adverse side effects profile and availability for on-demand usage are other advantages in this category. In 9 of 11 men with PE, prilocaine-lidocaine cream (EMLA [eutectic mixture of local anesthetics], Astra Pharmaceuticals, Wayne, PA, USA) was shown to markedly improve IELT without any reported adverse events [28]. In phase II testing, topical eutectic mixture for PE (TEMPE), when used as an aerosol 15 minutes before intercourse, resulted in a 3.8 minute increased in IELT, compared to 0.7 minutes for the placebo. While this constituted a 2.4-fold improvement over placebo, the numbers were too small to establish a statistically significant difference [27].
How long should a man last before ejaculating?
The topical application of anesthetic creams has the disadvantage of requiring a somewhat messy application within a condom, and the entire shaft is anesthetized. Aerosol TEMPE formulation, on the other hand, requires a decreased time for prior application, and only the glans penis is anesthetized [27,29]. This aerosol formulation is undergoing phase III trials in the United States, but is not Food and Drug Administration (FDA) approved at the time of this writing. So far, there has been an agreement neither on the amount of medication nor on the timeframe for its application. Recommended times for application have ranged from hour to 20 minutes prior to intercourse [29]. In phase II testing, topical eutectic mixture for PE (TEMPE), when used as an aerosol 15 minutes before intercourse, resulted in a 3.8 minute increased in IELT, compared to 0.7 minutes for the placebo. While this constituted a 2.4-fold improvement over placebo, the numbers were too small to establish a statistically significant difference [27].
- Pills may work by desensitizing penile nerves temporarily.
- Certain antidepressants are used off-label for PE.
- Not all pills are suitable for every age or health condition.
- Effectiveness varies among individuals; patience is necessary.
- Some formulations combine multiple ingredients for synergy.
The topical application of anesthetic creams has the disadvantage of requiring a somewhat messy application within a condom, and the entire shaft is anesthetized. Aerosol TEMPE formulation, on the other hand, requires a decreased time for prior application, and only the glans penis is anesthetized [27,29]. This aerosol formulation is undergoing phase III trials in the United States, but is not Food and Drug Administration (FDA) approved at the time of this writing. So far, there has been an agreement neither on the amount of medication nor on the timeframe for its application. Recommended times for application have ranged from hour to 20 minutes prior to intercourse [29]. compared the application of EMLA cream 20, 30, and 45 minutes before intercourse, and found 20 minutes to be the optimum period before anticipated intercourse for topical application [30]. In a double-blinded, randomized, placebocontrolled study of 42 patients—lidocaineprilocaine vs. placebo—the IELT improved with treatment from 1.49 to 8.45 minutes with lidocaine-prilocaine, while use of the placebo only increased the IELT from 0.7 to 1.9 minutes [31]. The application of an EMLA cream preparation—either lidocaine (2.5%) or prilocaine (2.5%)—20 to 30 minutes prior to intercourse has met with success [1]. In a placebo-controlled trial in 84 patients, when EMLA topical cream alone was compared with sildenafil alone or in combination with EMLA application, topical EMLA alone proved efficacious and had equal effectiveness to topical EMLA plus sildenafil therapy [2]. Similarly, a double-blind, randomized, placebocontrolled phase III clinical study of 106 patients with lifelong PE was conducted in three medical centers to investigate the efficacy of penile application of SS-cream.
| Product | Dosage | Quantity + Bonus | Price | |
|---|---|---|---|---|
| Viagra Super Active | 100mg | 30 + 6 Pills | 64.09€ 61.04€ | |
| Cialis Professional | 40mg | 10 Pills | 65.09€ 61.99€ | |
| Viagra Super Active | 100mg | 180 + 20 Pills | 280.97€ 267.59€ | |
| Cialis Generic | 20mg | 180 + 10 Pills | 254.09€ 241.99€ | |
| Cialis Generic | 10mg | 20 Pills | 48.23€ 45.93€ | |
| Cialis Generic | 5mg | 270 + 10 Pills | 205.81€ 196.01€ | |
| Kamagra Effervescent Tablets | 100 mg | 84 + 7 Pills | 202.91€ 193.25€ | |
| Viagra Oral Jelly | 100mg | 10 Sachets | 46.36€ 44.15€ | |
| Cialis Generic | 40mg | 120 + 8 Pills | 206.98€ 197.12€ | |
| Kamagra Oral Jelly | 100mg | 21 Sachets | 95.92€ 91.35€ | |
| Viagra Generic | 150mg | 180 + 10 Pills | 236.46€ 225.20€ | |
| Viagra Professional | 100mg | 270 + 6 Pills | 456.97€ 435.21€ | |
| Levitra Professional | 20mg | 180 + 4 Pills | 502.31€ 478.39€ |
This herbal mixture, made from the extracts of nine natural products, was applied hour prior to intercourse and provided a dose-dependent clinical efficacy in 80% of men using the cream, as compared to 15% in the placebo group.
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The SSRIs sertraline and fluoxetine were shown to be more effective than placebo in this 1998 controlled study [43]. Importantly, treatment with the SSRI sertraline was nearly as effective in delaying ejaculation as clomipramine, but had a significantly lower incidence of side effects. SSRIs may cause an increase in latency time as early as 2–3 days after the initiation of oral therapy. This effect tends to plateau after 3–4 weeks, with a six- to eightfold increase in IELT [44,45]. In order of clinical response, a meta-analysis of 35 studies of daily SSRI treatment found that paroxetine was the most effective, followed by fluoxetine, then sertraline, and lastly fluvoxamine [19].
Lidocaine 2.5% and prilocaine 2.5% (EMLA)
The same group also set out to assess whether the ejaculatory-delaying effects of at least some SSRIs may be applicable in men with “less-rapid” ejaculation. Following treatment with paroxetine 20 mg/day, the percentage increase in the geometric mean IELT compared with baseline in patients treated with paroxetine was 420% in patients with classic PE (less than or equal to 1 minute) and 480% in those with less rapid PE (greater than 1 minute), indicating that the paroxetine-induced percentage increase in IELT appeared to be independent of the baseline IELT, and that the findings may be extrapolated to men with less-rapid ejaculation. Other studies have documented efficacy for different SSRIs. For example, sertraline was found to be effective in improving IELT, ejaculatory control, and sexual satisfaction [46–48]. Similarly, a recent report on the efficacy of duloxetine in treating PE showed that treatment with this SSRI increased the IELT from 38.21 16.45 seconds to 129.34 seconds 67.58 (P = 0.001 vs. IELT increased to greater than 2 minutes. After treatment, the mean ejaculatory latency was prolonged to 2.45 +/– 0.29 sex for man tablet minutes in the placebo group, and 10.92 +/– 0.95 minutes in the SS-cream group [32]. General objections to all forms of topical therapy include complaints of significant penile hypoanesthesia and risk of transvaginal absorption with vaginal numbness, unless a condom is utilized [1]. Irritating topical reactions, both penile and vaginal, can occur, and systemic reactions are also possible [31]. Efforts to wash off the medication prior to intercourse may reduce the risk of these side effects, but also reduce the spontaneity of the coital experience [12,33].
Premature Ejaculation Treatment
control) [49]. Fluvoxamine is an SSRI unrelated in its chemical structure to other SSRIs or to clomipramine. Of all the SSRIs, it seems to have the least effect on prolonging IELT. This information may be helpful in advising psychiatrists, as they select an antidepressant for sexually asymptomatic men for whom further prolongation of IELT would be undesired [19,50]. Escitalopram has been shown to be efficacious in the treatment of PE.
Transcutaneous posterior tibial nerve stimulation (TPTNS)
It should be mentioned that as compared with other SSRIs, citalopram has not shown the greatest efficacy, and the ejaculatory-delaying effects are definitely inferior to paroxetine [51]. SS-cream studies have shown relatively minor side effects.
Pelvic physical therapy (PT)
In 1973, the use of clomipramine and other tricyclic antidepressants was advocated, signaling the beginning of a new era in the approach to treating PE that will be discussed in the following segments of this review [39]. On-Going, Long-Term Medications on a Daily Basis Selective Serotonin Reuptake Inhibitors (SSRIs) Treatment with an SSRI activates the 5-HT2C receptor, adjusts the ejaculatory threshold set point, and delays ejaculation [1]. The extent of this delay varies widely depending upon the type, dose, and frequency of SSRI administration and the genetically determined ejaculatory threshold set point. The ability of SSRIs to delay ejaculation was first uncovered serendipitously during the use of these medications in the treatment of depressed men in the 1970s [40]. Fluoxetine was next shown to be helpful in the intentional treatment of PE [41].
Neuromuscular electrical stimulation
Subsequently, a placebo-controlled trial of paroxetine proved promising [42]. A double-blind, fixed-dose trial of randomly assigned 20- or 40-mg daily doses of paroxetine in 27 patients with primary PE showed a statistically significant improvement in ejaculation time with both doses, as compared to placebo. Because the increase in the IELT was relatively similar in both groups, the authors concluded that daily 20-mg paroxetine “may be considered as an adequate treatment for primary premature ejaculation,” but that a higher dose may further increase the ejaculatory latency [42]. Kim and Seo compared the efficacy and safety of 4 weeks each of fluoxetine, sertraline, clomipramine, and placebo in treating PE in 36 men. As compared with an IELT increase from a baseline vardenafil 5 mg of 46 seconds to 2.27 minutes with placebo, therapy with the other agents resulted in increased IELT to 2.30, 4.27, and 5.75 minutes with the other agents, respectively. These include mild local burning and mild pain without systemic adverse effects or adverse effects on sexual function or partner. Based on the level of evidence ratings of the studies reviewed, treatment of PE with topical anesthetics received a grade A recommendation from an expert panel at the Second International Consultation on Sexual Medicine [1]. The search for an effective, oral agent to remedy PE has been hampered by the complexity, variability, and subjectivity of this condition as noted earlier. Nevertheless, trials of centrally acting agents date back to as early as 1943 [34].
Causes Of Premature Ejaculation
Psychogenic causes include anxiety, an unpleasant introductory or early sexual experience, infrequent sexual intercourse, poor ejaculatory control techniques, and evolutionary as well as psychodynamic factors. Urologic causes, including chronic prostatitis, have also been implicated [14]. Early animal studies revealed that nonselective agonists of the 5-HT2C receptors delay ejaculation, but selective 5-HT2A agonists do not have a similar effect, and selective 5-HT1A agonists cause a shorter ejaculatory latency compared with 5-HT2C agonists [15,16]. hypothesized that PE may be secondary to relative hyposensitivity of the 5-HT2C and/or 5-HT1A hypersensitivity [17]. The effect of postsynaptic 5-HT receptor activation on delayed ejaculation was later confirmed by using different selective serotonin reuptake inhibitors (SSRIs) [18–22].
No awkward doctor visits. Get premature ejaculation treatment all online.
The possible influence of genetic causes was investigated in a survey of 1,196 men in Finland that suggested the presence of a familial or genetic influence in 28% of men [23]. Decreasing sensory perception in the penis has been the goal of most topical agents aimed at treating PE. As a general rule, reliable controlled studies have been lacking in this area. Penile biothesiometry studies have shown that patients with PE have increased penile sensitivity as shown by consistently decreased vibratory threshold that is not age dependent [24,25]. Lidocaine- or prilocaine-based sprays, creams, or gels, as well as eutectic (i.e., melts easily) mixtures, have shown promise [26,27]. Some of the earlier medical approaches to the problem involved the use of alpha amino benzoate as well as various alpha blockers. Phenoxybenzamine, as well as more selective alpha blockers, such as terazosin and alfuzosin, were among the first agents utilized. The adverse event profile of these medications, however, led to their gradual phaseout as other therapies emerged. In 1973, the use of clomipramine and other tricyclic antidepressants was advocated, signaling the beginning of a new era in the approach to treating PE that will be discussed in the following segments of this review [39]. On-Going, Long-Term Medications on a Daily Basis Selective Serotonin Reuptake Inhibitors (SSRIs) Treatment with an SSRI activates the 5-HT2C receptor, adjusts the ejaculatory threshold set point, and delays ejaculation [1]. The extent of this delay varies widely depending upon the type, dose, and frequency of SSRI administration and the genetically determined ejaculatory threshold set point. The ability of SSRIs to delay ejaculation was first uncovered serendipitously during the use of these medications in the treatment of depressed men in the 1970s [40]. Fluoxetine was next shown to be helpful in the intentional treatment of PE [41]. Subsequently, a placebo-controlled trial of paroxetine proved promising [42]. A double-blind, fixed-dose trial of randomly assigned 20- or 40-mg daily doses of paroxetine in 27 patients with primary PE showed a statistically significant improvement in ejaculation time with both doses, as compared to placebo. Because the increase in the IELT was relatively similar in both groups, the authors concluded that daily 20-mg paroxetine “may be considered as an adequate treatment for primary premature ejaculation,” but that a higher dose may further increase the ejaculatory latency [42]. Kim and Seo compared the efficacy and safety of 4 weeks each of fluoxetine, sertraline, clomipramine, and placebo in treating PE in 36 men. As compared with an IELT increase from a baseline vardenafil 5 mg of 46 seconds to 2.27 minutes with placebo, therapy with the other agents resulted in increased IELT to 2.30, 4.27, and 5.75 minutes with the other agents, respectively. The SSRIs sertraline and fluoxetine were shown to be more effective than placebo in this 1998 controlled study [43]. Importantly, treatment with the SSRI sertraline was nearly as effective in delaying ejaculation as clomipramine, but had a significantly lower incidence of side effects. SSRIs may cause an increase in latency time as early as 2–3 days after the initiation of oral therapy. This effect tends to plateau after 3–4 weeks, with a six- to eightfold increase in IELT [44,45]. In order of clinical response, a meta-analysis of 35 studies of daily SSRI treatment found that paroxetine was the most effective, followed by fluoxetine, then sertraline, and lastly fluvoxamine [19]. The same group also set out to assess whether the ejaculatory-delaying effects of at least some SSRIs may be applicable in men with “less-rapid” ejaculation.
About this article
compared the application of EMLA cream 20, 30, and 45 minutes before intercourse, and found 20 minutes to be the optimum period before anticipated intercourse for topical application [30]. In a double-blinded, randomized, placebocontrolled study of 42 patients—lidocaineprilocaine vs. placebo—the IELT improved with treatment from 1.49 to 8.45 minutes with lidocaine-prilocaine, while use of the placebo only increased the IELT from 0.7 to 1.9 minutes [31]. The application of an EMLA cream preparation—either lidocaine (2.5%) or prilocaine (2.5%)—20 to 30 minutes prior to intercourse has met with success [1]. In a placebo-controlled trial in 84 patients, when EMLA topical cream alone was compared with sildenafil alone or in combination with EMLA application, topical EMLA alone proved efficacious and had equal effectiveness to topical EMLA plus sildenafil therapy [2].
Fluoxetine (Prozac)
Similarly, a double-blind, randomized, placebocontrolled phase III clinical study of 106 patients with lifelong PE was conducted in three medical centers to investigate the efficacy of penile application of SS-cream. This herbal mixture, made from the extracts of nine natural products, was applied hour prior to intercourse and provided a dose-dependent clinical efficacy in 80% of men using the cream, as compared to 15% in the placebo group. IELT increased to greater than 2 minutes. After treatment, the mean ejaculatory latency was prolonged to 2.45 +/– 0.29 sex for man tablet minutes in the placebo group, and 10.92 +/– 0.95 minutes in the SS-cream group [32]. General objections to all forms of topical therapy include complaints of significant penile hypoanesthesia and risk of transvaginal absorption with vaginal numbness, unless a condom is utilized [1]. Following treatment with paroxetine 20 mg/day, the percentage increase in the geometric mean IELT compared with baseline in patients treated with paroxetine was 420% in patients with classic PE (less than or equal to 1 minute) and 480% in those with less rapid PE (greater than 1 minute), indicating that the paroxetine-induced percentage increase in IELT appeared to be independent of the baseline IELT, and that the findings may be extrapolated to men with less-rapid ejaculation. Other studies have documented efficacy for different SSRIs. For example, sertraline was found to be effective in improving IELT, ejaculatory control, and sexual satisfaction [46–48]. Similarly, a recent report on the efficacy of duloxetine in treating PE showed that treatment with this SSRI increased the IELT from 38.21 16.45 seconds to 129.34 seconds 67.58 (P = 0.001 vs.
- Some PE pills are designed to be used as needed before sex.
- Side effects vary based on pill composition and individual health.
- It's important to differentiate between temporary and chronic PE.
- Combining pills with mindfulness training can improve sexual control.
- Educating oneself about PE helps in making informed choices.
control) [49]. Fluvoxamine is an SSRI unrelated in its chemical structure to other SSRIs or to clomipramine.
Side effects of premature ejaculation pills
Irritating topical reactions, both penile and vaginal, can occur, and systemic reactions are also possible [31]. Efforts to wash off the medication prior to intercourse may reduce the risk of these side effects, but also reduce the spontaneity of the coital experience [12,33]. SS-cream studies have shown relatively minor side effects. These include mild local burning and mild pain without systemic adverse effects or adverse effects on sexual function or partner. Based on the level of evidence ratings of the studies reviewed, treatment of PE with topical anesthetics received a grade A recommendation from an expert panel at the Second International Consultation on Sexual Medicine [1].
2. Condoms
The search for an effective, oral agent to remedy PE has been hampered by the complexity, variability, and subjectivity of this condition as noted earlier. Nevertheless, trials of centrally acting agents date back to as early as 1943 [34]. Some of the earlier medical approaches to the problem involved the use of alpha amino benzoate as well as various alpha blockers. Phenoxybenzamine, as well as more selective alpha blockers, such as terazosin and alfuzosin, were among the first agents utilized. The adverse event profile of these medications, however, led to their gradual phaseout as other therapies emerged. Of all the SSRIs, it seems to have the least effect on prolonging IELT. This information may be helpful in advising psychiatrists, as they select an antidepressant for sexually asymptomatic men for whom further prolongation of IELT would be undesired [19,50].
- Prescription pills must be taken under medical supervision.
- Natural remedies often include ingredients like ginseng or yohimbine.
- Over-the-counter delay sprays can also help.
- Consistent use of certain medications may reduce PE frequency.
- Psychological counseling can be effective for performance anxiety.
Escitalopram has been shown to be efficacious in the treatment of PE.
| Mechanism | Description | Example Drugs/Ingredients | Effect Duration | Notes |
|---|---|---|---|---|
| Local Anesthetic Effect | Numbs the penis to temporarily reduce sensitivity | Lidocaine, Prilocaine | 30-60 minutes | Used in creams/spays |
| Serotonin Reuptake Inhibition | Alters neurotransmitter levels to delay ejaculation | Dapoxetine, SSRIs | 1-3 hours | Prescription medications |
| Central Nervous System Modulation | Influences brain pathways controlling ejaculation | Tramadol, certain antidepressants | 2-4 hours | Off-label use |
It should be mentioned that as compared with other SSRIs, citalopram has not shown the greatest efficacy, and the ejaculatory-delaying effects are definitely inferior to paroxetine [51].
