SOURCE: Kirby EW, et al. Tramadol for the management of premature ejaculation: A timely systematic review. Int J Impot Res 2015;27:121-127.

Premature ejaculation is reported to be the most common sexual dysfunction among men, although it may not appear that way to clinicians since patients often do not seek help for the problem.

Since routine inquiry into sexual health issues often does not occur, and since there are no FDA-approved medications to treat premature ejaculation, it is not surprising that patients fail to bring forward the problem. As late as 1998 (the year of the advent of Viagra), 90% of impotent men reported they did not discuss their sexual health problem with a clinician, citing 1) their complaint might be disregarded, 2) there might not be any remedy, and 3) the clinician might be embarrassed by discussing such issues.

To date, selective serotonin reuptake inhibitors (SSRIs) have been the most commonly used effective treatment for premature ejaculation. SSRIs have shown efficacy on both a scheduled and pro re nata basis. Kirby et al recently reported on the efficacy of tramadol for premature ejaculation.

Based on results from eight articles published in peer-reviewed journals, most of which were placebo-controlled or comparison trials to paroxetine (the most commonly used SSRI for premature ejaculation), the authors conclude that on-demand doses of 25-50 mg tramadol administered 2-4 hours prior to intercourse is effective in prolonging vaginal ejaculatory latency time and compares well with SSRIs in head-to-head trials.