Have you ever had a patient in clinic complaining of premature ejaculation (PE)? This was not something that I saw much in training. Currently, most of what I see in practice is related to urologic oncology, but still see some general urology on a regular basis. I recently had a young gentleman in clinic that I had treated with circumcision for phimosis and in his a postop visit was complaining of significant PE. SSRIs have been used in treatment of PE in the past, but I was not anxious to start this gentleman on such medical treatment as first line therapy. A colleague told me about a new topical medication, Promescent®, a topical spray that does not require a prescription and is available over the counter. In the 1980’s, the FDA released a monograph which stated that PE could be treated with topically-applied lidocaine. Monographs, with regards to the FDA, represent published standards by which a substance is automatically approved. Research had also been done into a topical anesthetic containing prilocaine that showed efficacy but had a rare side effect of methemoglobinemia, and thus has not been approved by the FDA for use in the treatment of PE. Dr. Ronald Gilbert, a urologist in southern California, started Absorption Pharmaceuticals and worked to develop a topical spray, containing lidocaine only, for the treatment of PE. This product has since been marketed as Promescent. Promescent is a eutectic formulation containing un-ionized lidocaine. Un-ionized lidocaine more effectively penetrates the skin, compared to ionized lidocaine. When I was at the recent annual meeting of the American Urological Association, I had the pleasure of meeting the Promescent® team of Absorption Pharmaceuticals. As a small business person myself, I like promoting other small businesses. Absorption Pharmaceuticals is based in Huntington Beach, CA and is actively growing their presence in the urology market. Earlier this year, they received indications from the U.S. PTO that it will issue Absorption Pharmaceuticals for Promescent as a novel lidocaine-only eutectic formulation. On a sad note, Dr. Ronald Gilbert, the founder of Absorption Pharmaceuticals died tragically in January of 2013. If you want to learn more about Promescent, its MOA, and prescribing information, I recommend you check out their website, or you can view this pdf of their product monograph.