What is the efficacy of lidocaine (lidocaine) gel in treating premature ejaculation?

From the Guidelines

Lidocaine gel is a recommended first-line treatment for premature ejaculation, and it can be applied topically to the penis 20-30 minutes before sexual activity. According to the most recent guideline on disorders of ejaculation, clinicians should recommend daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice in the treatment of premature ejaculation 1. The guideline suggests that topical penile anesthetics, such as lidocaine gel, can be effective in delaying ejaculation.

When using lidocaine gel, it is essential to follow the recommended application guidelines to minimize side effects. Apply a small amount (about a pea-sized portion) of 2-5% lidocaine gel or cream to the glans penis and frenulum 20-30 minutes before sexual activity, then wipe off any excess before intercourse 1. This topical anesthetic works by temporarily reducing penile sensitivity, which helps delay ejaculation. Most over-the-counter products like Promescent or K-Y Duration contain lidocaine in appropriate concentrations.

Some key points to consider when using lidocaine gel for premature ejaculation include:

• Side effects are generally mild and may include temporary numbness, mild irritation, or reduced sensation for both partners if not wiped off properly.
• Combining lidocaine with behavioral techniques like the stop-start method or squeeze technique may provide better results.
• If using condoms, choose latex or polyurethane types as they're compatible with lidocaine products.
• If symptoms persist after several attempts or if you experience skin irritation, consult a healthcare provider as other treatment options may be more appropriate for your situation.

It is crucial to note that lidocaine gel should be used with caution, and patients should be advised about potential side effects and interactions. The reduction of penile sensation may limit the acceptability of this method of treatment, and diffusion of residual topical anesthetic on the penis into the vaginal wall also may result in numbness in the partner 1.

From the Research

Lidocaine Gel for Premature Ejaculation

• Lidocaine gel or spray has been studied as a potential treatment for premature ejaculation (PE) in several clinical trials 2, 3, 4, 5.
• A study published in 2021 found that lidocaine 5% spray significantly improved PE symptoms, intravaginal ejaculatory latency time (IELT), and sexual intercourse frequency in patients with lifelong PE 2.
• Another study from 1995 reported significant improvement in premature ejaculation using a lidocaine-prilocaine cream, with no adverse effects noted 4.
• A 2017 review discussed the use of lidocaine/prilocaine spray for PE, highlighting its potential as a treatment option 3.
• A dose- and time-finding study published in 2023 found that a regimen of three sprays of prilocaine/lidocaine spray administered 5 minutes before sexual intercourse showed the best results in terms of ejaculation time and control, with a safe safety profile 5.
• It is worth noting that while lidocaine gel or spray may be effective in treating PE, other treatments such as selective serotonin re-uptake inhibitors (SSRIs) have also been shown to be effective in improving PE symptoms, satisfaction with intercourse, and perceived control over ejaculation 6.

Comparison with Other Treatments

• SSRIs have been found to probably improve self-perceived PE symptoms, satisfaction with intercourse, and perceived control over ejaculation compared to placebo, but may increase treatment cessations due to adverse events and adverse event rates 6.
• The use of lidocaine gel or spray may be considered as an alternative or complementary treatment to SSRIs, depending on individual patient needs and preferences.
• Further research is needed to fully understand the efficacy and safety of lidocaine gel or spray compared to other treatments for PE.

Safety and Efficacy

• The safety profile of lidocaine gel or spray has been found to be generally well-tolerated, with few adverse effects reported 2, 4, 5.
• The efficacy of lidocaine gel or spray in treating PE has been demonstrated in several clinical trials, with significant improvements in IELT, sexual intercourse frequency, and patient-reported outcomes 2, 4, 5.