Clinical medical research about premature ejaculation (PME) revolves around the experiences of cisgender man, or someone was assigned male at birth and they identify as male and/or a man (meaning they aren’t transgender). Therefore, much of what we know about PME for transgender, nonbinary, and intersex people is largely based on community knowledge. Either way, it’s important to know that treatments are available to anyone who was assigned male at birth and still has a penis.
Premature ejaculation is extremely common.
Premature ejaculation refers to when someone ejaculates (or comes/cums) before they would ideally like to. This usually happens to everyone born with a penis who still has one, so know that you are not alone. PME is one of the most common sexual performance frustrations, affecting the sex lives of one in three people with penises. For many people, early ejaculation means upon becoming aroused, coming anywhere from almost immediately to one to two minutes. One study found that the average time to ejaculation is 5.4 minutes while another found that an “adequate” length of time before ejaculating would be three to seven minutes, while seven to 13 minutes was more desirable.
With that said, coming “before you would like” is more of a personal metric, so it’s up to the person whose body it is to decide whether the time it takes to come is adequate for them. Maybe this is the perfect time for you! But if not, this health condition can contribute to added stress and performance anxiety of its own, impacting both your personal sexual experience and relationship with your sexual partner(s).
Likewise, although PME and erectile dysfunction (ED) are categorized under "sexual dysfunction" and "sexual problems" understand that expectations around sex and sexual function vary, and there is nothing wrong with your body. However, giving these concerns a medical diagnosis allows you to seek medical treatment if you want to change the current functions of your sex life. For those who experience both ED and PME, we recommend trying an ED medication first before undergoing PME treatments.
Unsure if it’s PME? Pay attention to how often you experience it.
You may be familiar with the experience of ejaculating sooner than anticipated, which is 100& normal and also not a cause for concern. People who experience any of the following frequently may want to consider PME treatments:
- coming almost immediately after being aroused and having sexual stimulation
- having difficulty preventing ejaculation
- feeling anxious, unhappy, or disappointed with any sexual activity to such an extent that you avoid it (which can also lead to relationship problems)
What does the symptom management of premature ejaculation look like?
There are two different paths of common treatment of premature ejaculation: Lidocaine (numbing) cream and SSRIs (selective serotonin reuptake inhibitors). Both are safe and effective when prescribed by health providers and therefore aren’t available over the counter. There are also sprays less commonly prescribed, though this article will focus on numbing cream and SSRIs.
One type of treatment to treat premature ejaculation is a topical numbing cream used as needed for sexual activity. Lidocaine is a commonplace topical anesthetic that reduces the sensitivity or numbs, the skin, muscles, or tissues it’s applied to. Used for PME, this numbing cream can reduce sensitivity in the penis, which can lead to a longer period of time before ejaculation during any sexual activity. Lidocaine was approved by the Food and Drug Administration (FDA) in 1948.
Numbing cream can be used as needed, applied to the tip of the penis. It takes around 20 to 30 minutes to start working. While rare, some experience side effects with numbing cream like a burning sensation, skin irritation, or rash. If you experience side effects, stop using the medication and be sure to consult a trusted health care provider for medical advice.
Another option for PME treatment includes SSRIs (selective serotonin reuptake inhibitors). Some may also be familiar with these for their use as antidepressants. SSRIs increase the amount of serotonin (the key hormone that stabilizes mood, feelings of well-being, and happiness) in the brain. A common side effect of SSRIs, which works well for those who experience premature ejaculation, is that they can increase how long it takes to come during any sexual activity, such as sexual intercourse and masturbation.
Since there are so many SSRIs, you may have to try more than one to find the type that works for you. Once you do, it can typically take two to three weeks for the body to adjust and to see the effects. Additionally, there are some side effects that might mean you want to try out different SSRIs that feel right for your body. Common side effects from SSRIs also may include a dizzy or fuzzy-headed feeling, sleep disturbances, weight changes, dry mouth, or headache, but most of these go away over time. It’s important to note that these side effects can vary greatly from person to person. FOLX believes in Health at Every Size (HAES) and never believes weight gain to be a bad thing.
There are some pre-existing medical conditions that impact whether someone should or shouldn’t consider taking SSRIs. These conditions may include a QT prolongation, which is an abnormality of the rhythm of the heart that is diagnosed on an EKG (electrocardiogram). Because some SSRIs can make the QT longer, the combination can lead to a dangerous and life-threatening heart rhythm. If you have a history of unusual heart beats, rhythms, or blood electrolyte abnormalities, you would need to consult a provider to determine if SSRIs are safe for you.
For people with bleeding disorders or for those taking blood thinners, SSRIs may have a very small effect on how well the blood clots. However, studies have shown that most people taking blood thinners can safely take SSRIs. For those on Coumadin (warfarin), it is important to monitor INR (International Normalised Ratio) or how long it takes blood to form a clot). People with a history of blood clots being treated with this medication should let their health care provider know about starting a new medication
People with additional pre-existing medical conditions or diagnoses that should consult their clinician if considering SSRIs include: people at risk for bipolar disorder or in people taking certain medicines that increase serotonin. Also, people with poorly controlled bleeding disorders, seizure disorders, and liver disease will need to review if SSRIs are safe for them, and if so, which SSRI might work best. SSRIs can also worsen narrow eye glaucoma and put vision at risk.
Although FOLX isn’t yet able to prescribe treatment for premature ejaculation, we currently recommend you contact your health care provider. FOLX can prescribe medication for erectile dysfunction, if you are interested in getting started, please click here. If you don't feel comfortable speaking to your primary care provider or don't have one, you can find a local LGBTQIA+ friendly clinic through this list.