Lidocaine cream can be used on the genitals and around the anus, and doctors use it there for procedures and for premature ejaculation. Whether it helps depends on why you’re using it, because it works well for some genital problems and poorly for others.
Why Genital Skin Absorbs Lidocaine So Quickly
The thin, moist lining of the genitals absorbs numbing cream faster than ordinary skin, and numbness starts in about 5 to 10 minutes.1FDA. EMLA Cream The face, scalp, genitals and mucous membranes also have a rich blood supply, so a given amount of cream puts more drug into the bloodstream there than it would on the trunk or limbs.2PubMed Central. Risk-Stratified Use of Topical and Infiltrative Local Anesthetics in High-Risk Dermatologic Surgery Scrotal skin absorbs about 40 times more than forearm skin.3Cutis. Methemoglobinemia Induced by Application of an Anesthetic Cream A dose that is harmless on your arm can be too much on your genitals.
Which tissue you’re treating matters. The head of the penis (especially if uncircumcised), the inner folds of the labia and the vaginal opening are moist mucosal tissue that takes up the drug quickly. The outer vulva, the penile shaft and the scrotum are skin, but thinner and better supplied with blood than the arm, so they absorb more than the packaging assumes. Skin that is cracked, freshly shaved, scratched or inflamed has lost part of its barrier and absorbs even faster, so skip the cream there or ask a clinician first.
Fast onset changes how you use the product. Package directions and clinic timings written for the forearm or the back of the hand assume slow absorption, so on genital tissue they can overshoot by a wide margin. A practical approach is to put a pea-sized amount on the specific spot and wipe it off once numbness appears, rather than waiting out the full printed time.
Products differ too. Common ones include plain lidocaine creams and a lidocaine-prilocaine mix sold as EMLA, which is a prescription numbing cream.4PubMed Central. Ulcerative vulvar irritant contact dermatitis from eutectic mixture of local anesthetics cream in 2 patients Strength, total area covered and how long the cream stays on all change how much of the drug gets into the body.5PubMed. Topical anesthetics for dermatologic procedures: a review
Using Lidocaine for Premature Ejaculation
Numbing creams and sprays lengthen the time to ejaculation better than a placebo, and in pooled results lidocaine also did better than pills such as paroxetine or sildenafil.6PubMed Central. Topical Anesthetics and Premature Ejaculation: A Systematic Review and Meta-Analysis They also improve control and sexual satisfaction for couples, and side effects are uncommon.7Uro. Topical Treatment of Premature Ejaculation: The Rise of Anesthetic Spray Formulations? In one small group of men using lidocaine-prilocaine cream, most rated the result excellent or better and none had side effects.8PubMed. Efficacy of prilocaine-lidocaine cream in the treatment of premature ejaculation
Timing matters. In one study, about 20 minutes on the skin before sex worked best with lidocaine-prilocaine cream, and men lasted an average of nearly 7 minutes.9PubMed. Optimum usage of prilocaine-lidocaine cream in premature ejaculation Sprays are usually left on for 10 to 15 minutes and then wiped off carefully before intercourse.10PubMed. Topical lidocaine-prilocaine spray for the treatment of premature ejaculation: a proof of concept study Wipe or wash off any cream left on the skin before penetration, to protect your partner and your own sensation.
Start with a thin layer on the head of the penis only. That is the most sensitive area, and the shaft usually needs none. Too much cream or too long a wait can numb the penis so heavily that you lose your erection or feel little during sex. If the first try seems weak or works too well, change one thing at a time over several encounters, usually the waiting time, rather than piling on more cream.
A doctor is the better next step if premature ejaculation has lasted since your first sexual experiences or causes real distress. Behavioral approaches such as the start-stop and squeeze techniques, often practiced with a partner, can help and carry no drug risk. Rushed ejaculation sometimes develops because of erection difficulty, since men may hurry to finish before losing the erection, and a doctor can look for that. Prescription sprays made for this purpose deliver a set dose per spray, which is easier to control than squeezing cream from a tube.
Lidocaine for Vulvar and Vaginal Pain
As a long-term treatment, lidocaine has a weak record. In a controlled trial, lidocaine, alone or combined with an antidepressant pill, reduced chronic vulvar pain (vulvodynia) no more than a dummy treatment.11PubMed Central. Oral Desipramine and Topical Lidocaine for Vulvodynia Pooled studies of pain at the vaginal entrance found that treatments did not reliably reduce pain with sex.12PubMed. Systematic review and meta-analysis of the effects of treatment modalities for vestibulodynia in women Still, some clinics advise applying lidocaine to the painful spots before sex for short-term relief.13Tripler Army Medical Center. Using topical lidocaine for pain at the vaginal opening
If you try it, put a small amount on a cotton swab and touch it only to the spots that hurt, rather than spreading it across the whole vulva or deep into the vagina. Give it several minutes to work, then test the area gently before penetration so you don’t push through pain the numbness isn’t covering. Tell your partner you used it, because some of it can transfer during sex and cause mild numbness or tingling for them.
Absorption inside the vagina is low risk at normal doses. Lidocaine gel placed in the vagina at strengths up to 10% produced blood levels 10 to 20 times lower than the levels used to treat heart rhythm problems.14PubMed Central. Pharmacokinetics of Lidocaine and Its Metabolites Following Vaginal Administration of Lidocaine Gel to Healthy Female Subjects
Pain at the vaginal entrance has many possible sources, including yeast or other infections, skin conditions such as lichen sclerosus, tight pelvic floor muscles and oversensitive nerves. Each is treated differently, and numbing cream does nothing for any of them beyond quieting the signal for a while. A gynecologist, often with a referral to pelvic floor physical therapy, can examine the area and offer treatment aimed at the actual cause.
Lidocaine for Hemorrhoids and Anal Pain
Hemorrhoid products with lidocaine give fast relief from pain and itching during a flare.15PubMed Central. Hemorrhoid management in women: the role of tribenoside + lidocaine An ointment combining lidocaine with nifedipine, which relaxes the anal muscle, helps heal chronic anal tears and painful clotted hemorrhoids.16PubMed. Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease After hemorrhoid surgery, the combination controlled pain better than lidocaine alone.17PubMed Central. Topical nifedipine with lidocaine ointment versus active control for pain after hemorrhoidectomy: results of a multicentre, prospective, randomized, double-blind study
Apply a small amount only to the skin outside the anus, since these creams aren’t meant to be pushed deep inside unless a product is designed for that. Bleeding that lasts more than a few days, or severe pain, calls for a medical visit, because hemorrhoids are not the only cause and numbing can mask a problem that needs treatment.
Daily use for weeks gives the skin more chances to develop an allergy, which can look like worsening itching and be mistaken for the hemorrhoid itself. If symptoms persist beyond about a week of home treatment, a clinician can check whether another treatment would work better.
The Main Safety Risks
Wrapping or covering numbed skin with plastic or any material increases the chance of serious side effects.18U.S. Food and Drug Administration. FDA Warns Consumers to Avoid Certain Topical Pain Relief Products Due to Potential for Dangerous Health Effects Putting EMLA on broken skin or mucous membranes raises the risk of toxicity.19BC Drug & Poison Information Centre. Case Report: EMLA Cream and Methemoglobinemia In one reported case, EMLA put on eroded scrotal skin under a dressing caused methemoglobinemia, a condition in which the blood can’t carry oxygen properly.20Cutis. Methemoglobinemia Induced by Application of an Anesthetic Cream Prilocaine and a substance the body makes from it change hemoglobin so it can no longer carry oxygen.21Cutis. Methemoglobinemia Induced by Application of an Anesthetic Cream
Watch for these warning signs:
- Bluish or gray lips, fingertips or skin
- Shortness of breath, headache, dizziness or a racing heart
- Ringing ears, confusion or a metallic taste, which can signal too much lidocaine in the blood
- If any of these appear, wash the cream off and get emergency care
Some creams sold online or in stores contain a higher percentage of lidocaine than standard pharmacy products, and they are often marketed for tattoos or hair removal rather than the genitals. On tissue that absorbs quickly, a stronger cream means more drug in the blood faster, which makes the risks above more likely. It doesn’t numb more safely or more effectively. Choose a pharmacy product that clearly states its strength and instructions, and avoid unlabeled or imported tubes.
Some people need extra caution. Those with heart rhythm problems or liver disease should ask a clinician first, because the liver clears lidocaine and the heart is sensitive to its effects. Anyone with a blood condition that affects how hemoglobin carries oxygen, such as G6PD deficiency or methemoglobinemia, or who has had a reaction to prilocaine, should avoid lidocaine-prilocaine cream because it raises the risk of the blood-oxygen problem. Using several numbing products on the same day, including sprays, gels and creams, adds up in the bloodstream, so tell a clinician about all of them.
Irritation and Allergic Reactions
Topical medicines, including numbing creams, are the most common causes of allergic rashes on the genitals.22PubMed. Genital Allergic Contact Dermatitis Among people with genital or anal skin problems who had allergy patch testing, about 1 in 11 reacted to a medicine they used, most often numbing creams or steroid creams.23PubMed. Iatrogenic allergic contact dermatitis in the (peri)anal and genital area EMLA has caused irritation, hives, blisters and, in two women, open sores on the vulva.24PubMed Central. Ulcerative vulvar irritant contact dermatitis from eutectic mixture of local anesthetics cream in 2 patients
Burning, redness or itching that gets worse each time you use the cream, or that spreads beyond where you applied it, points toward a reaction rather than the original condition. Because the cream is often used for itching or pain, a reaction is easily mistaken for the problem getting worse, which leads people to apply more. The first step is to stop the product and give the skin several days to settle; bland moisturizers or petroleum jelly can help meanwhile.
If the rash persists or returns, a dermatologist can do patch testing to identify the cause. It isn’t always the lidocaine, since preservatives or other ingredients in the cream can trigger the same rash.
Partners, Condoms and Sex
Partners sometimes feel mild numbness when lidocaine ointment or jelly is used before sex.25Tripler Army Medical Center. Using topical lidocaine for pain at the vaginal opening A liquid applied only to sore spots usually doesn’t numb a partner.26Tripler Army Medical Center. Using topical lidocaine for pain at the vaginal opening Cream left on the genitals can also numb a partner’s lips, tongue or throat, which is unpleasant and can affect swallowing. Wash the area thoroughly with soap and water before any oral contact rather than only wiping it.
Condoms react differently to these products. Natural latex condoms were unaffected after 15 minutes of exposure to a lidocaine-prilocaine spray, but polyurethane condoms weakened within 5 minutes and failed quality standards.27(not provided). Study on the compatibility of lidocaine/prilocaine aerosol with polymer condoms Use latex condoms with these products, or check the label.
Lidocaine for Waxing, Laser and Medical Procedures
Doctors use lidocaine for many procedures. Lidocaine cream reduces discomfort during laser hair removal, even when the device also cools the skin.28PubMed. Topical anesthesia for laser hair removal: comparison of spot sizes and 755 nm versus 800 nm wavelengths Numbing cream worked as well as an injection for many women having stitches after childbirth.29PubMed. Comparison between lidocaine-prilocaine cream (EMLA) and mepivacaine infiltration for pain relief during perineal repair after childbirth: a randomized trial Lidocaine-prilocaine cream has been used under a covering for about an hour before circumcision, under medical supervision.30PubMed. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision In newborns, a lidocaine cream eased circumcision pain without measurable drug in the blood.31PubMed. Safety and efficacy of a topical anesthetic for neonatal circumcision For vulvar skin samples, doctors use numbing cream followed by an injection.32The Vulva. Vulvar procedures
At home before bikini waxing or laser, apply the cream only to the exact area being treated rather than the whole bikini region, because absorption is high and a larger area means more drug in the blood. Ask the clinic how long to leave it on and whether it should be covered, since timing rules differ between procedures.
Don’t cover the area with plastic wrap at home unless a medical professional tells you to. Either way, wash off the cream at the start of the session, because leftover product can interfere with the procedure or irritate skin. Numbness can also hide burns or skin damage, so tell the clinician you used it.