What role do topical anesthetics play in the management of premature ejaculation, and how should they be prescribed?

Topical anesthetics play a key role in the management of premature ejaculation by reducing penile sensitivity, thereby delaying ejaculation and improving control during sexual activity. They are typically applied shortly before intercourse to the glans penis to achieve a localized numbing effect without systemic side effects ¹. Prilocaine/lidocaine sprays are commonly used topical anesthetics for this purpose, with recent evidence supporting specific dosing and timing to optimize efficacy and minimize adverse effects such as loss of erection or partner numbness. For example, a dose- and time-finding study demonstrated that applying prilocaine/lidocaine spray approximately 10-15 minutes before intercourse provides effective delay in ejaculation with a favorable safety profile (Cai et al., 2023).

Recommended prescribing practices include advising patients to apply the topical anesthetic in a measured dose to the glans penis, allowing sufficient time for absorption, and washing off excess prior to intercourse to reduce the risk of transference to the partner. Clinicians should counsel patients on correct usage, potential side effects, and the importance of adherence to dosing instructions to maximize benefit and minimize complications ¹.

In summary, topical anesthetics such as prilocaine/lidocaine sprays are an effective, well-tolerated option for premature ejaculation management when used according to evidence-based dosing and timing guidelines, combining UK clinical recommendations with recent pharmacological research findings (Cai et al., 2023) ¹.