# Premature Ejaculation - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: EAU Guidelines on Sexual and Reproductive Health 2024 · UK eMC Fortacin Spray / EMLA 5% Cream SmPC (or DailyMed EMLA Cream Package Insert) - Verified date: 2026-08 ## Verified against - EAU Guidelines on Sexual and Reproductive Health 2024 - UK eMC Fortacin Spray / EMLA 5% Cream SmPC (or DailyMed EMLA Cream Package Insert) - Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt) ## Treatment metadata - Dapoxetine — 30 mg — oral.solid - Referral & safety-netting (no drug therapy) - Paroxetine — oral.solid - Fluoxetine — oral.solid - Sertraline — oral.solid - Citalopram — oral.solid - Escitalopram — oral.solid - Lidocaine + Prilocaine — topical - Behavioral therapy and sex counseling ## Complete treatment card ```text PREMATURE EJACULATION Sources: EAU Guidelines on Sexual and Reproductive Health 2024 · UK eMC Fortacin Spray / EMLA 5% Cream SmPC (or DailyMed EMLA Cream Package Insert) Review status: REVIEWED against EAU Guidelines on Sexual and Reproductive Health 2024, UK eMC Fortacin Spray / EMLA 5% Cream SmPC (or DailyMed EMLA Cream Package Insert), Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - A sense of loss of ejaculatory control tied to stress, anxiety, or nervousness rather than any physical dysfunction [anxiety] - Associated emotional strain including anxiety, depression, and diminished self-esteem is common [anxiety · low mood] - It means ejaculation happening, again and again, sooner than the man or his partner would wish - Around 30% of men have it, and some reviews put it as high as 75% - It is the commonest male sexual disorder there is - Roughly 3 in 10 men aged 18 to 59 have trouble with it, and shame keeps most of them from ever raising it in the consultation - The occasional episode does not matter; what does harm is the chronic pattern, which brings anxiety, depression and discord at home [anxiety · low mood] - Once it has run a year or more it starts to damage the couple, and depression tends to follow [low mood] - To count as the diagnosis it has to have run at least 6 months and be causing him real distress TESTS (10) - Testosterone and prolactin may be checked when premature ejaculation coexists with erectile dysfunction or low libido suggestive of hypogonadism - Testosterone replacement does not fix the ejaculatory problem even though low testosterone is more common in these men - A thyroid-stimulating hormone level is reasonable when excess thyroid hormone is suspected, since treating it can improve symptoms - No laboratory or imaging study is routinely needed to make the diagnosis - Specialized studies such as penile vibration threshold testing, nerve conduction studies, and hormone panels remain investigational, not routine - A psychosexual evaluation by a mental health professional experienced with male sexual dysfunction is part of the standard workup - By the sexual medicine criteria: within about a minute of penetration since the very first sexual experience is the lifelong form, and a drop to about 3 minutes or less that troubles him is the acquired form - The second limb of that definition is that he cannot delay it on nearly every occasion - The third is what it costs him: distress, bother, frustration, and avoiding intimacy altogether - DSM-5 asks for about a minute after penetration, before he wishes it, on 75% to 100% of occasions IF NOT THIS - what else fits (2) - Markedly delayed orgasm in the female partner can make ordinary ejaculation timing look like premature ejaculation - Adverse effects of psychotropic medications should be weighed as a contributing factor Source StatPearls "Premature Ejaculation" - disease-level clinical article Status traced to the source above 1. DAPOXETINE [1st line] Adult 30 mg orally taken 1 to 3 hours before intended sexual activity (max 60 mg once daily if 30 mg tolerated but insufficient) - On-demand PRN Peds Not indicated in pediatric populations under 18 years Choice Dapoxetine is the first choice here; paroxetine, fluoxetine, sertraline, citalopram and escitalopram are further options. Source EAU Guidelines on Sexual and Reproductive Health 2024 Why Dapoxetine is a short-acting SSRI designed specifically for on-demand use before intercourse; its rapid onset and clearance delay ejaculation without the accumulation seen with standard SSRIs taken daily. Caution Contraindicated in severe heart failure, significant ischemic heart disease, heart block, or severe hepatic impairment. Do not combine with MAOIs, CYP3A4 inhibitors, or other SSRIs/SNRIs. May cause dizziness, nausea, headache, syncope, or orthostatic hypotension; advise patient to stay hydrated. Egypt DAPOXEMED 30 MG 3 F.C. TABS. MEDIZEN PHARM... 17.50 EGP (5.83/unit) MATUJAC 30 MG 3 F.C. TABS. HOCHSTER PHAR... 21.00 EGP (7.00/unit) WESTOXETIN 30 MG 3 F.C. TABS. WESTERN PHARM... 21.00 EGP (7.00/unit) EJADAXTIN 30 MG 3 F.C. TABS. WADI ELNEEL B... 23.00 EGP (7.67/unit) PREDAPOX 30 MG 6 F.C. TABS. ADWIA 86.00 EGP (14.33/unit) DELEPE 30 MG 3 F.C. TABS. PENTA PHARMA-... 45.00 EGP (15.00/unit) DERILGY 30 MG 3 F.C. TABS. MASH PREMIERE... 65.00 EGP (21.67/unit) PRILIGY 30 MG 3 F.C. TABS. MENARINI > EG... 382.00 EGP (127.33/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Dapoxetine has a poor side-effect profile and extremely high discontinuation rates in European data. 3. PAROXETINE [1st line] Adult 10 to 40 mg/day Peds Paroxetine should not be used in the treatment of children and adolescents under the age of 18 years. That sentence is the Paroxetine 20 mg film-coated tablets SmPC section 4.2, verbatim. Source Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt) Why Off-label daily SSRI used as initial drug of choice to delay ejaculatory onset in premature ejaculation. Caution May cause sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction). Avoid abrupt withdrawal to prevent serotonin discontinuation syndrome. Egypt XANDOL 20MG 20 TAB. EUROPEAN EGYP... 42.00 EGP (2.10/unit) PAXETIN 20 MG 10 F.C.TABS. PHAROPHARMA 22.80 EGP (2.28/unit) DEPANX 20MG 10 F.C. TAB. GLOBAL NAPI P... 24.00 EGP (2.40/unit) PAROXETINE 20 MG 30 F.C.TABS. EVA PHARMA 93.00 EGP (3.10/unit) PAROXETINE CR 12.5 MG 30 F.C.TABS. EVA PHARMA 99.00 EGP (3.30/unit) PAROXEDEP CR 37.5 MG 30 F.C.TABS. APEX PHARMA 117.00 EGP (3.90/unit) SEROXAT CR 25MG 30 F.C.TABS. GLAXO SMITHKLINE 321.00 EGP (10.70/unit) PAROXEDUR XL 25 MG 30 EXT. REL. F.C. TABS. P&C LABS > BIOMED 94.50 EGP 4. FLUOXETINE [1st line] Adult 20 to 40 mg/day Peds FLUOXETINE should only be used in children and adolescents aged 8 to 18 years for the treatment of moderate to severe major depressive episodes and it should not be used in other indications. Source Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt) Why Off-label daily SSRI used to delay ejaculatory onset in premature ejaculation. Caution May cause sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction). Long half-life; monitor for drug interactions. Egypt ALZAC 10MG 20 CAPS. FUTURE PHARMA... 18.00 EGP (0.90/unit) FLUOZAC 10MG 20 CAPS. JEDCO INT. CO... 18.00 EGP (0.90/unit) PHILOZAC 10MG 10 CAPS. AMOUN 9.00 EGP (0.90/unit) FLUTIN 20 MG 14 CAPS. EIPICO 26.00 EGP (1.86/unit) OCTOZAC 20MG 10 CAPS. OCTOBER PHARMA 21.60 EGP (2.16/unit) PROZAC 20MG 14 CAPS. ELI LILLY 118.00 EGP (8.43/unit) DURAZAC WEEKLY 90MG 4 DELAYED REL. CAPS. BIOPHARM EGYPT > ANDALOUS PHARMA 48.00 EGP FIESTO 90MG 4 DELAYED RELEASE CAPS. INTERNATIONAL DRUG AGENCY (IDI) > SI... 48.00 EGP 5. SERTRALINE [1st line] Adult 50 to 200 mg/day Peds Sertraline should not be used in the treatment of children and adolescents under the age of 18 years, except for patients with obsessive compulsive disorder aged 6-17 years old. That sentence is the LUSTRAL 50 mg film coated tablets SmPC section 4.2, verbatim. Source Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt) Why Off-label daily SSRI used to delay ejaculatory onset in premature ejaculation. Caution May cause sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction). Take with food to reduce gastrointestinal side effects. Egypt OPIRALINE 50 MG 20 F.C. TABS. EL-OBOUR 29.00 EGP (1.45/unit) AGRELOCIT 50 MG 20 TAB. MEMPHIS > ATM... 34.80 EGP (1.74/unit) DEPR-STAT 50MG 10 CAPS. MEMPHIS 21.60 EGP (2.16/unit) OPIRALINE 100MG 10 F.C.TAB. EL-OBOUR 32.00 EGP (3.20/unit) SIRTO 50MG 10 F.C. TABS. HI-PHARM 34.00 EGP (3.40/unit) MOODAPEX 100 MG 30 F.C.TAB. MULTI-APEX 123.00 EGP (4.10/unit) LUSTRAL 50 MG 20 F.C.TABS. VIATRIS 136.00 EGP (6.80/unit) SERLIFT 100MG 10 F.C. TAB. GLOBAL NAPI P... 74.00 EGP (7.40/unit) 6. CITALOPRAM [1st line] Adult 20 to 40 mg/day Peds No paediatric dose is stated in the sources held for this drug. Source Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt) Why Off-label daily SSRI used to delay ejaculatory onset in premature ejaculation. Caution May cause sexual dysfunction and QTc prolongation at higher doses. Egypt CITALIFE 10 MG 20 F.C.TAB. UNIPHARMA CO.... 31.20 EGP (1.56/unit) PURACIT 20MG 14 F.C. TAB. GLOBAL NAPI P... 36.00 EGP (2.57/unit) CEROPRAM 20MG 14 TAB. EGPI 42.00 EGP (3.00/unit) TALOPRAM 40MG 30 F.C. TAB. ADWIA 108.00 EGP (3.60/unit) RAMDEEP 40 MG 10 F.C. TAB. WESTERN PHARM... 43.00 EGP (4.30/unit) CITALO 40 MG 30 F.C.TAB. DELTA PHARMA 180.00 EGP (6.00/unit) CIPRAM 20 MG 28 TABS. H.LUNDBECK A/... 232.00 EGP (8.29/unit) LECITAL 40MG 30 F.C.TAB. JOSWE MEDICAL... 255.00 EGP (8.50/unit) RAMDEEP 2MG/ML SYRUP 120ML WESTERN PHARM... 21.75 EGP -> ? strength differs, ? different route - not oral solid CITALO 2MG/ML ORAL SOLUTION 120 ML DELTA PHARMA 38.00 EGP -> ? strength differs, ? different route - not oral solid 7. ESCITALOPRAM [1st line] Adult 10-20 mg/day Peds Escitalopram should not be used in the treatment of children and adolescents under the age of 18 years (see section 4.4). That sentence is the Escitalopram 10 mg film-coated tablets SmPC section 4.2, verbatim. Source Premature Ejaculation - disease-level clinical article (premature-ejaculation-full.txt) Why Off-label daily SSRI used to delay ejaculatory onset in premature ejaculation. Caution May cause sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction). Egypt HERMPRO 5 MG 20 F.C.TABS. SABAA > SOVAL... 24.00 EGP (1.20/unit) ESCTIKANA 10 MG 14 F.C.TABS. HOCHSTER PHAR... 17.00 EGP (1.21/unit) CITALOMEP 10 MG 14 F.C.TABS. MEPACO 26.00 EGP (1.86/unit) MOODAMASH 10 MG 14 F.C. TABS. MASH PREMIERE 63.00 EGP (4.50/unit) ESCITA 10 MG 14 F.C.TABS. GENESIS PHARM... 77.00 EGP (5.50/unit) JOVIAPRAM 20 MG 30 F.C. TABS. SUN PHARMA EG... 201.00 EGP (6.70/unit) CIPRALEX 10 MG 28 F.C.TABS. LUNDBECK > MU... 392.00 EGP (14.00/unit) TALOSCITO 20 MG 30 SCORED F.C. TABS. P & C LABS 157.50 EGP XYGAROT 5MG/5ML SYRUP 100ML MULTI-APEX 21.00 EGP -> ? strength differs, ? different route - not oral solid ESCITALOBORG 5 MG/5ML SYRUP 125 ML BORG 50.00 EGP -> ? strength differs, ? different route - not oral solid 8. LIDOCAINE + PRILOCAINE [2nd line] Adult For Fortacin spray: 3 actuations (sprays) applied to glans penis 5 minutes before intercourse. For EMLA 5% cream: apply 1-2 g (thin layer) to glans penis 15-30 minutes before intercourse, wiped off prior to penetration. - On-demand PRN Peds Not applicable - condition restricted to adult males Source Fortacin 150 mg/ml + 50 mg/ml cutaneous spray solution SmPC (eMC product 100391). Section 4.1: "Fortacin is indicated for the treatment of primary premature ejaculation in adult men." Section 4.2: "3 actuations applied to cover the glans penis"; "After 5 minutes any excess spray should be wiped off prior to intercourse"; "A maximum of 3 doses can be used within 24 hours with at least 4 hours between doses." The EMLA figure shown alongside comes from a different product and rests on no named document - see the caution. Why Lidocaine-prilocaine is a topical local anesthetic combination applied to the glans to reduce sensitivity and delay ejaculation; it offers a non-oral alternative to dapoxetine, though residue must be wiped off or a condom used to avoid numbing the partner. Caution Fortacin's own ceiling: "A maximum of 3 doses can be used within 24 hours with at least 4 hours between doses." Prilocaine can cause methaemoglobinaemia, so the limit matters. THE EMLA ROUTE IS OFF-LABEL AND ITS FIGURE RESTS ON NO NAMED DOCUMENT. EMLA Cream 5% SmPC section 4.1 (eMC 7994) carries no premature-ejaculation indication. Its only genital-skin figures sit under "Skin of male genital organs - Prior to injection of local anaesthetics": "1 g/10 cm2 for 15 minutes" or "1-2 g/10 cm2 for 60 minutes". The same SmPC states that application to genital skin "should only be performed by or under the supervision of a healthcare professional". Fortacin is the licensed alternative here. Must wipe off residue before intercourse or use a condom to prevent numbness in partner. Avoid applying to broken or inflamed penile skin. Contraindicated in history of allergy to local anaesthetics of the amide type. Egypt MELACAINE 5% CREAM 15 GM > MELANO PHARMA 36.50 EGP EMLA 5% CREAM 5 GM 5 TUBES ASTRA ZENECA ... 120.00 EGP PRIDOCAINE TOPICAL CREAM 15 GM GLOBAL NAPI P... 32.00 EGP ANASEZIAGO CREAM 30 GM AL ESRAA PHAR... 55.00 EGP AVRISURG TOPICAL CREAM 30 GM MEDIZEN PHARM... 55.00 EGP PRIDOCAINE TOPICAL CREAM 30 GM GLOBAL NAPI P... 55.00 EGP MANOVIPERCAINE PLUS TOPICAL SPRAY 15 ML EVA PHARMA 56.00 EGP 9. BEHAVIORAL THERAPY AND SEX COUNSELING [add-on - not a substitute] Adult Practice behavioral techniques (stop-start technique, squeeze technique, pelvic floor muscle training) regularly during sexual activity - Ongoing (minimum 4-8 weeks) Peds Not applicable Source EAU Guidelines on Sexual and Reproductive Health 2024 Why Stop-start and squeeze techniques, together with pelvic floor training, teach the patient to recognize and control arousal levels; they are used alongside pharmacologic or topical treatment and work best combined with partner communication and anxiety reduction. Caution The best results are achieved when this is combined with partner communication and anxiety reduction. Rule out co-existing erectile dysfunction or thyroid disorders prior to initiating therapy. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)