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What is EMLA cream?

Eutectic mixture of local anaesthetics (EMLA) cream is a surface anaesthetic cream, which works by blocking pain receptors on the skin. It is oil-based and is often used as a treatment option for premature ejaculation by men, allowing longer periods of sexual interaction.

How long does EMLA cream take to work?

EMLA cream takes between 15 and 30 minutes to work. Usually, it is recommended that you apply the cream about 20 minutes before you want to have sex.

What is EMLA cream used for?

EMLA cream stands for eutectic mixture of local anaesthetics and is used for numbing the surface of the skin for a short time. It contains two active ingredients called lidocaine and prilocaine, which are both local anaesthetics. EMLA cream is commonly used by adult males as a topical treatment for premature ejaculation.

How does EMLA cream work?

The anaesthetic ingredients of EMLA cream – lidocaine and prilocaine – numb the surface of the skin by reducing the levels of sensitivity and pain reflexes in the area. When applied to the penis, the reduction in sensitivity can delay sexual climax and allow the man to last longer.

EMLA cream does not treat the underlying cause of premature ejaculation in men. However, it can help relieve the worry of ejaculating too early, helping men to relax and enjoy sex.

How effective is EMLA cream?

Studies have found that the use of EMLA cream on the penis significantly increases the time before ejaculation concluding that it is an effective treatment of premature ejaculation.

How does EMLA cream affect sex?

By reducing sensitivity around the head of the penis, EMLA helps the man to have sex for longer before ejaculating. It is important to remove any excess cream from the penis before intercourse to avoid causing numbing or irritation to your sexual partner or use a condom to prevent transmission. When used correctly, EMLA can make sex more relaxing and satisfying for both participants. 

Applying EMLA to the penis can lessen sexual enjoyment. In clinical trials, those who applied it more than 20 minutes prior to sex were more likely to experience loss of erection. If this becomes a problem, you may wish to try an oral treatment instead, such as Priligy.

Can I use EMLA cream for oral and anal sex?

EMLA can be also be used for oral and anal sex, however, bear in mind that the cream can be transmitted to your partner and cause numbness or loss of sensation. EMLA cream should not be ingested, therefore for oral sex, you should use a condom, or ensure all EMLA cream is removed from the penis prior to oral sex.

Is EMLA cream for premature ejaculation off-label use?

EMLA cream is licensed for use as a local anaesthetic cream. Due to its numbing qualities, it has also been found to be effective for premature ejaculation, however, this use is not covered by the original license. Evidence shows that EMLA cream can be a safe and effective treatment for premature ejaculation, but extending a license can be an expensive process, so manufacturers often choose to avoid this. Doctors may prescribe medications for off-label use when it is considered to be the most appropriate treatment available. You can learn more about off-label use of medications here.

EMLA cream summary

Active ingredients

EMLA cream contains the active ingredients lidocaine and prilocaine, which belong to a group called local anaesthetics. Each gram of EMLA cream contains 25mg each of lidocaine and prilocaine. 

Inactive ingredients

The other ingredients of EMLA cream are macrogolglycerol hydroxystearate, Carbomer 974P, sodium hydroxide and purified water.

How to use EMLA cream safely

EMLA cream is an anaesthetic; and will numb the penis to pain and temperature, therefore you should be vigilant for any injury that may occur. The dosage should not be used more than necessary, and should never be orally ingested. In case of swallowing the cream, contact your pharmacy or doctor. EMLA cream should also be used with caution in the elderly, and around women who are pregnant or breastfeeding.

How to use EMLA cream

When using EMLA to prevent premature ejaculation, a moderate amount of EMLA cream should be applied to the head of the penis 20 minutes before intercourse. Make sure to wipe off any excess to avoid numbing your partner, or causing irritation; alternatively, you can use a latex-free condom. As EMLA cream is oil-based, it can weaken latex condoms and increase the risk of them tearing. It is advisable to wear polyurethane condoms that are not weakened by EMLA.

What dosage of EMLA cream should I use?

EMLA cream contains the active ingredients lidocaine and prilocaine, which are local anaesthetics. Each gram of EMLA contains 25mg of lidocaine and 25mg of prilocaine. The general rule is that 1g of EMLA cream can be applied to an area of skin up to 10cm². For application on the penile head area, the general recommendation is to use 1g (a pea-sized amount) of EMLA 20 minutes prior to sexual intercourse. 

When should EMLA cream be applied?

When used to treat premature ejaculation, EMLA cream should be applied around 20 minutes prior to commencing sexual activity. This is because EMLA typically takes between 15 and 30 minutes to take full effect. In clinical trials, those who applied EMLA more than 20 minutes before sex were more likely to experience erectile problems.

EMLA side effects

Common side effects, which may affect up to 1 in 10 people, include local skin reactions such as paleness, redness, swelling, a mild burning or itching sensation, around the treated area.

Uncommon side effects may affect up to 1 in 100 people, and include continuation and worsening of the above symptoms and extended numbness or tingling in the treated area.

Up to 1 in 1,000 people may experience the following rare side effects: allergic reactions (which in rare cases may develop into anaphylactic shock, characterised by a skin rash, swelling, fever respiratory difficulties and fainting), methaemoglobinaemia (blood disorder), small, dot-shaped bleeding on the treated area. EMLA can also cause irritation if it comes into contact with the eyes. 

If you are troubled by side effects, stop using the treatment and seek advice from a doctor.

Contraindications

You should not use EMLA Cream if you are allergic to lidocaine or prilocaine, other similar anaesthetics or any of the other ingredients in this medication. Before using EMLA cream, inform your doctor if you have any of the following:

• Glucose-6-phosphate dehydrogenase deficiency, a rare inherited illness that affects the blood.
• Methemoglobinemia, a problem that affects blood pigment levels.
• Atopic dermatitis, an itchy skin condition that may require a shorter application time when using EMLA cream.

If you are pregnant, ask your doctor or pharmacist for advice before using EMLA cream. Short term use is unlikely to have any effect on you or the foetus. While lidocaine and prilocaine are passed into breast milk, the amount is so small as to pose no risk to the child. 

Drug interactions

You should inform your doctor if you are using, have recently used, or may soon be taking other medications. This includes prescription-free medications and herbal medications. EMLA cream can affect the way some medications work or increase the risk of developing side effects.
In particular, you should inform your doctor if you are using the following medications

• Other anaesthetics. 
• Sulphonamides (medicines used to treat infections) and nitrofurantoin.
• Phenytoin and phenobarbital, medicines used to treat epilepsy.
• Medicines to treat an uneven heartbeat, such as amiodarone.
• Cimetidine or beta-blockers, which may cause an increase in the blood levels of lidocaine.

Why choose EMLA cream?

Premature ejaculation is a common problem amongst men of all ages and has the potential to bring significant anxiety and stress into a relationship, and loss of confidence to the individual. EMLA cream acts as an effective relief from the worry caused by premature ejaculation. When applied correctly, it delays ejaculation and allows intercourse to continue for longer. As a topical treatment, it is easy to apply, while any potential side effects are limited to the skin area.

EMLA vs Priligy

While EMLA cream isn’t licensed specifically for premature ejaculation, dapoxetine, marketed as Priligy, is a prescription medication developed specifically to help with the problem. EMLA is a topical cream applied directly to the penis, while Priligy is taken orally in tablet form. Dapoxetine works by altering the function of serotonin, which is responsible for the communication of pleasure signals to the brain. When taken 1–3 hours before sex, dapoxetine helps achieve better control over climax.

Since dapoxetine is an antidepressant, Priligy is only usually prescribed if other treatments, such as EMLA cream, have failed to achieve results. It is only available on prescription.

Alternatives to EMLA cream

While EMLA cream is considered the most effective numbing agent, it can be expensive. EMLA stands for eutectic mixture of local anaesthetics and contains both lidocaine and prilocaine. Cheaper alternatives can be bought over the counter and usually contain lidocaine only, at a low enough strength not to require a prescription.

However, EMLA cream remains the most effective prescription-free numbing agent. The use of alternatives as a treatment for premature ejaculation can not be guaranteed, and their use in the genital area may not be recommended. It is best to consult a doctor to discuss which product may be best for you.

Can you use EMLA cream with condoms?

As an oil-based treatment, EMLA has a weakening effect on latex condoms and can increase the chance of tearing. As a precaution, you may choose to wear polyurethane condoms that are not weakened by oil.

Is EMLA cream available over the counter?

EMLA cream is a prescription-free medication and can be bought over the counter at registered pharmacies. Alternatively, fill in a 2-minute questionnaire at Dr Felix to order online. While it is not specifically licensed for treatment of premature ejaculation, it is commonly used for this purpose with positive results.

Can EMLA be used for injections?

EMLA is used to numb the skin in preparation for injections, but only when recommended and applied by a healthcare professional. 
 

Can I use EMLA for a tattoo or for tattoo removal?

EMLA can be used to relieve the pain of getting a tattoo or having one removed. It is important to speak to your tattoo artist first, as the application of EMLA can change the skin surface texture and they will advise you on how to apply. It is recommended that you apply EMLA to the appropriate area about an hour before work begins, and wrap it tightly in cling film in the meantime to ensure the best results.

Can I use EMLA cream before waxing?

Some people find that EMLA is effective as a numbing agent when waxing, while others experience very little results. If you chose to use EMLA for waxing, it is important to be mindful that when the sensation of pain is reduced, it is harder to tell if your skin is being damaged during the waxing process. It is therefore unwise to use EMLA as a numbing agent when waxing sensitive areas such as your underarms or bikini line.

Can EMLA be used in the mouth?

EMLA cream should not be applied inside the mouth, nose or eyes.

Can EMLA cream be used for piercings?

EMLA can be used as a numbing agent when getting a piercing, although its effectiveness may vary. Some piercing studios may offer EMLA as an option and will provide advice on its application.

Can I use EMLA cream if my shoes are rubbing?

While EMLA may effectively reduce the pain caused by blisters or rubbing shoes, its use, in this case, is not recommended. When the pain caused by rubbing is reduced, damage to the skin is more likely to advance unnoticed, increasing the chance that the skin will break and become infected. Using blister plasters and switching to more comfortable shoes are the best ways to relieve pain from rubbing and avoid nasty blisters.