Premature Ejaculation (PME): What’s Going on & What to Do

Premature ejaculation is quite common, but it can still be frustrating.

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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).

PME is super common.

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.

The key to knowing if it is PME is how frequently it happens.

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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
  • having difficulty preventing ejaculation
  • feeling anxious, unhappy, or disappointed with any sexual activity to such an extent that you avoid it

There are two common treatments for PME:

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Lidocaine (Numbing) Cream

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.

SSRIs

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
Drowsiness, sleepiness
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
Weight gain*

*FOLX believes in Health at Every Size (HAES) and never believes weight gain to be a bad thing!

There are some pre-existing conditions that impact whether someone should or shouldn’t consider taking SSRIs.

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. 

  • History of heart failure, heart attack, or enlarged heart
  • Slow heartbeat (bradycardia)
  • Low potassium (hypokalemia) or low magnesium (hypomagnesemia)

Additional pre-existing conditions that should kept in mind if considering SSRIs include: 

  • Bleeding disorder or taking blood thinners: SSRIs may have a very small effect on how well the blood clots. However, studies have shown that those taking blood thinners can safely take the pills. 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 this condition should let their primary care clinician or specialist know about starting a new medication.
  • Seizure disorder: SSRI pills can slightly increase the tendency to have a seizure. This is a concern for those who have seizures either with or without seizure medication. For people doing well on seizure medication, SSRIs would not change the risk.
  • Severe liver disease (cirrhosis) or taking medications processed by the liver: People with severe liver disease can have trouble processing medications. Since SSRI pills are processed by the liver, people with severe liver problems end up with higher amounts of the medication in their blood, which can also worsen the underlying liver disease. SSRIs can also affect how well other medications that are processed by the liver work.
  • Glaucoma or high eye pressure: SSRIs may raise the pressure in the eye. People over the age of 60, have a family history of glaucoma, or have high blood pressure or diabetes are more prone to having high eye pressure. If eye pressure is too high, it can lead to blindness.

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.