Prilocaine is a local anesthetic often combined with lidocaine in a topical spray or cream. It temporarily reduces penile sensitivity and may help delay ejaculation. A lidocaine/prilocaine spray is authorized in the European Union for lifelong premature ejaculation in adult men, but products and instructions vary by country. It is not a cure, and the right product and use should be confirmed with a healthcare professional.
How does prilocaine help delay ejaculation?
Prilocaine is a local anesthetic, meaning it temporarily reduces sensation in the area where it is applied. For premature ejaculation, it is commonly combined with another local anesthetic called lidocaine. Together, these medicines reduce sensitivity in the glans, or head, of the penis. This can make stimulation feel less intense and may help a person delay ejaculation during sexual activity.
According to the European Medicines Agency (EMA), the combination of lidocaine and prilocaine in the topical spray Fortacin works by blocking nerve signals in the treated area. The effect is local and temporary. It does not directly address every possible factor contributing to premature ejaculation, and the amount of benefit depends on the product and the individual response.
Does prilocaine work for premature ejaculation?
Clinical evidence supports the use of certain topical anesthetics to help delay ejaculation. The American Urological Association and Sexual Medicine Society of North America guideline describes topical anesthetics such as lidocaine and prilocaine as an established treatment option with moderate effectiveness. These medicines can be useful for people who prefer an on-demand treatment applied shortly before sexual activity.
In two placebo-controlled studies summarized by the EMA, adults using the lidocaine/prilocaine spray Fortacin experienced longer average times before ejaculation than participants using a placebo spray. Participants also reported improvements in ejaculation control and sexual satisfaction. These findings support the specific studied formulation; they do not guarantee the same results for every person or for every cream, gel, or spray containing an anesthetic.
The benefit is generally intended for the sexual encounter in which the product is used. Prilocaine does not permanently change penile sensitivity, and it should not be considered a cure for premature ejaculation. If a product does not help when used according to its instructions, a healthcare professional can review whether another approach would be more appropriate.
Is prilocaine available as a cream or a spray?
Products containing prilocaine are available in different formulations and combinations. Some topical creams contain both lidocaine and prilocaine, while specific sprays have been developed and studied for premature ejaculation. These products should not automatically be treated as interchangeable because their concentrations, approved uses, application methods, and instructions may differ.
The Mayo Clinic notes that topical numbing agents containing benzocaine, lidocaine, or prilocaine are sometimes used to help delay ejaculation. It also distinguishes these products from prescription lidocaine/prilocaine cream used in other medical contexts. A cream intended to numb the skin before a procedure is not necessarily labeled or formulated for penile use. Ask a clinician or pharmacist whether the exact product is suitable for this purpose.
Fortacin, a lidocaine/prilocaine spray, is authorized in the European Union for primary, or lifelong, premature ejaculation in adult men. Its regulatory status should not be assumed to apply to other countries. Availability, prescription requirements, and the products specifically approved for this use depend on the country.
How should a lidocaine/prilocaine product be used?
The correct application method depends on the exact formulation. For the EU-authorized Fortacin spray, the official EMA product information specifies three sprays to cover the glans of the penis. The instructions state that excess spray should be wiped off after five minutes and before intercourse. The product information also sets limits on how frequently doses may be used.
These directions apply to Fortacin, not automatically to EMLA cream, another topical anesthetic, or a compounded product. Do not copy the dose or waiting time from one formulation to another. Follow the specific product leaflet or the instructions provided by your healthcare professional. Applying more than directed or leaving a product on longer than recommended may increase unwanted numbness or other adverse effects.
What side effects can prilocaine cause?
The most relevant side effects of topical lidocaine/prilocaine products are local effects. These may affect both the person using the product and their sexual partner if the medicine is transferred during sexual contact.
- Reduced penile sensation: The penis may feel less sensitive than expected, which can reduce sexual pleasure.
- Burning or irritation: Some people experience burning, redness, discomfort, or other skin reactions in the treated area.
- Erection difficulties: Excessive loss of sensation may make it harder to maintain an erection.
- Reduced sensation in a partner: Contact with residual medicine may cause temporary numbness or burning in the partner's genital area or other exposed tissues.
The EMA lists reduced genital sensation, genital burning, and erectile dysfunction among the common adverse effects reported with Fortacin. Stop using the product and seek medical advice if irritation or a rash develops or persists. Seek emergency medical care for signs of a serious allergic reaction, such as swelling of the lips or throat or difficulty breathing.
How can you reduce the risk of numbing your partner?
Medicine remaining on the penis can transfer to a partner during sexual contact. This may reduce the partner's sensation and, in some cases, mask pain that would normally warn of irritation or injury. The NHS guidance on ejaculation problems specifically notes that topical anesthetics such as lidocaine and prilocaine can be transferred to the vagina and cause reduced sensation.
Follow the product's instructions for removing excess medicine before intercourse. A condom may help limit transfer, but compatibility depends on the formulation and condom material. For example, the Fortacin product information warns against using its spray with polyurethane condoms because the material may deteriorate. It identifies certain other materials, including latex rubber, polyisoprene, nitrile, and silicone, as compatible with that product. Check the instructions for the exact medicine and condom you use rather than assuming all combinations are suitable.
Who should check with a healthcare professional before using prilocaine?
Before using a topical lidocaine/prilocaine product for premature ejaculation, discuss your medical history and current medicines with a healthcare professional if you have a known allergy to the ingredients or related local anesthetics. Advice is particularly important for people with certain blood conditions, including glucose-6-phosphate dehydrogenase (G6PD) deficiency or methemoglobinemia, a condition that affects the blood's ability to carry oxygen. Severe liver disease and the use of certain other medicines may also affect the safety of treatment.
Prilocaine can contribute to methemoglobinemia, particularly with excessive exposure or certain interacting medicines. The risk depends on the product, dose, and personal health factors. MedlinePlus information on topical lidocaine and prilocaine advises patients to tell their healthcare professional about relevant medical conditions and medicines before use. Unusual gray or blue skin coloring, shortness of breath, marked dizziness, or a rapid heartbeat after exposure requires urgent medical assessment.
When is it worth discussing another treatment?
If premature ejaculation continues to cause distress, affects a relationship, or begins suddenly after a period of usual sexual function, a healthcare professional can help assess the situation. The discussion may cover the pattern of symptoms, medical history, other sexual concerns, and whether the current treatment is suitable. Treatment options may include other medicines, behavioral techniques, or psychosexual counseling, depending on the circumstances.
Prilocaine may be a useful option for some adults, particularly when the aim is to reduce penile sensitivity during sexual activity. The key is to choose an appropriate product, use it as directed, and consider both the potential benefit and the possibility of unwanted numbness or irritation in either partner.