Premature ejaculation is quite common, but it can still be frustrating.
Before we get into it, what we know right now about this is almost entirely based on cisgender men* and much of what we know about premature ejaculation (or “PME” for short) for trans, nonbinary, and intersex people is largely based on community knowledge. Either way, this article and these treatments are available to anyone who was assigned male at birth and still has a penis.
*cisgender men: if someone was assigned male at birth and they identify as male and/or a man (i.e. not a transgender person).
For people who were assigned male at birth and still have a penis: premature ejaculation in broadest terms is when someone ejaculates (or comes/cums) before they would ideally like to. PME is one of the most common sexual performance frustrations, affecting 1 in 3 people with penises. One study found that the average time to ejaculation is 5.4 minutes, and another found that an “adequate” length of time before ejaculating would be 3 to 7 minutes, while 7 to 13 minutes was more desirable. So for many people, premature ejaculation means upon becoming aroused, coming anywhere from almost immediately to 1-2 minutes.
This is to say that coming “before you would like,” is 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.
For those who experience erectile dysfunction (or "ED" for short— the inability to get or maintain an erection), in addition to premature ejaculation, we recommend trying an ED medication first, before treatments for PME are considered.
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:
One type of treatment to treat premature ejaculation is a numbing cream, used as needed for sexual activity. Lidocaine is a super common anesthetic that reduces the sensitivity, or numbs, the skin, muscles, or tissues it’s applied to. Used for premature ejaculation, this numbing cream can reduce sensitivity in the penis which can lead to a longer period of time before ejaculation during any sexual activity.
Numbing cream can be used as needed, and is simply applied to the tip of the penis, and takes around 20-30 minutes to work. While rare, some experience side effects with numbing cream like a burning sensation, skin irritation or rash.
Another option is a group of daily pills called 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.
Because there are so many SSRIs, you may have to try more than one to find the type that works for you, and once you do, it can take 2-3 weeks for the body to adjust and to see the effects.
There are some side effects, however, that might mean you want to try out different SSRIs that feel right for your body. It’s important to note that these side effects can vary greatly from person-to-person:
⚫ = likelihood to experience this side effect
|Citalopram (Celexa)||Escitalopram (Lexapro)||Fluoxetine (Prozac, Sarafem)||Fluvoxamine (Luvox)||Paroxetine (Paxil)||Sertraline (Zoloft)|
|Anticholinergic: Dry mouth, blurred vision, tendency toward overheating||⚫|
|Insomnia (inability to sleep), agitation||⚫||⚫||⚫⚫||⚫||⚫||⚫⚫|
|Orthostatic hypotension: a sudden drop in blood pressure going from sitting or laying, to standing||⚫||⚫||⚫||⚫||⚫⚫||⚫|
|QT prolongation: fast, chaotic, abnormal heartbeats, potentially leading to fainting||⚫⚫⚫||⚫⚫||⚫||⚫||⚫||⚫|
|Gastrointestinal toxicity: abdominal cramping, nausea, and diarrhea||⚫||⚫||⚫||⚫||⚫||⚫⚫|
*FOLX believes in Health at Every Size (HAES) and never believes weight gain to be a bad thing!
These pre-existing 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 deadly heart rhythm.
Additional pre-existing conditions that should kept in mind if considering SSRIs include:
While FOLX is not yet able to prescribe treatment for premature ejaculation, we currently recommend you contact your primary care provider. 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.