Topical anaesthetics reduce penile sensation, while behavioural and psychosexual approaches work on control, arousal and distress. Each has different advantages and limitations.
Topical anaesthetics and behavioural approaches address premature ejaculation in different ways. A lidocaine/prilocaine product temporarily reduces sensation at the head of the penis. Stop–start practice, psychosexual therapy and related approaches focus on recognising arousal, reducing distress and changing patterns around sex. They may be used separately or as part of a combined plan.
Lidocaine and prilocaine block nerve signals locally and temporarily reduce penile sensitivity. This may delay ejaculation, improve perceived control or reduce distress. Too much numbness can make sex less pleasurable or contribute to erection difficulty, so following the instructions matters.
Fortacin is a metered-dose lidocaine/prilocaine spray licensed for primary PE in adult men. The term “delay spray” is also used online for numerous products with different ingredients and regulatory status. Evidence and instructions for one product cannot automatically be applied to another.
The current Fortacin Summary of Product Characteristics states that one dose is three actuations applied across the glans penis. It is applied five minutes before sex and excess spray is wiped off. The maximum is three doses in 24 hours, separated by at least four hours.
Those instructions apply to Fortacin, not every lidocaine cream or spray. A prescriber or pharmacist should explain the exact product, and the supplied leaflet takes priority.
The most frequently reported effects in treated men in the Fortacin product information are genital numbness and erectile dysfunction. Burning, redness, altered sensation, pain or irritation can also occur. Female partners have reported vulvovaginal burning or numbness.
Transfer to the mouth, nose, throat, vagina or anus can temporarily numb tissue and mask pain, increasing the risk of local injury. Excess product should be removed as directed. Stop using the product if either person develops a rash or skin irritation, and seek advice if symptoms persist.
Avoid the eyes and ears. If it enters an eye, rinse immediately with water or saline and protect the eye until sensation returns.
Condom compatibility is product specific. Fortacin must not be used with polyurethane male or female condoms because the material may deteriorate, reducing protection against pregnancy or sexually transmitted infections. Its SmPC says it is compatible with contraceptive devices made from latex rubber, polyisoprene, nitrile and silicone.
Men trying to conceive are advised either to avoid Fortacin or, if it is needed for penetration, to wash the glans thoroughly five minutes after application and before intercourse. The product information states that a reduction in the chance of pregnancy cannot be excluded and that the spray is not a contraceptive.
| Approach | What it involves | Main consideration |
|---|---|---|
| Lidocaine/prilocaine spray | On-demand local desensitisation before sexual activity. | Follow the exact dose and transfer, condom and conception precautions. |
| Stop–start practice | Pausing stimulation as ejaculation approaches, then resuming after arousal falls. | Requires practice and may increase self-monitoring if treated as a performance test. |
| Squeeze technique | Pausing and applying brief pressure near the head of the penis before ejaculation. | Not comfortable or effective for everyone and is best learned with clear guidance. |
| Psychosexual therapy | Work on arousal, anxiety, beliefs, communication, avoidance and sexual satisfaction. | Access and time commitment vary; a suitably qualified practitioner is important. |
| Pelvic-floor work | Learning awareness and control of pelvic-floor muscles, sometimes with specialist support. | It should not be reduced to repeated unsupervised squeezing; technique and evidence vary. |
During solo or partnered stimulation, pause before the point at which ejaculation feels inevitable. Wait until arousal has reduced, then begin again. Repeat the cycle rather than trying to suppress ejaculation at the last instant.
The purpose is to recognise changes in arousal and develop more choice, not to reach a prescribed number of minutes. Start without the pressure of penetration or a target performance. If the exercise creates anxiety or conflict, pause it and consider psychosexual support.
The squeeze technique follows a similar cycle, but brief pressure is applied to the penis near the glans when ejaculation approaches. NHS information describes squeezing for about 10–20 seconds, then waiting around 30 seconds before resuming stimulation.
Pressure should not cause pain, bruising or injury. Stop if it is uncomfortable. Some people prefer stop–start practice because it is less physically disruptive.
Psychosexual therapy is not simply advice to “relax”. It may explore:
Look for a clinician with recognised psychosexual training. The NHS lists the College of Sexual and Relationship Therapists and the Institute of Psychosexual Medicine among professional routes for finding therapists.
Yes. A topical treatment may offer an on-demand effect while therapy addresses anxiety, communication or avoidance. EAU guidance supports psychological or behavioural therapy in combination with pharmacological treatment for acquired PE, although evidence is less certain than for licensed first-line medicines in lifelong PE.
Combination should still be deliberate. Adding multiple numbing products or using more than the labelled dose can increase numbness, irritation and erection problems.
Fortacin must not be used if the patient or partner is allergic to lidocaine, prilocaine or related amide local anaesthetics. Its product information contains cautions for severe liver disease, anaemia, glucose-6-phosphate dehydrogenase deficiency and methaemoglobinaemia, as well as interactions with certain medicines. A prescriber or pharmacist should assess uncertain allergy, medical or medicine histories.
