Tramadol and sex: the truth behind “the pill that makes it last”

9Why do young men link tramadol with sex?

“My friend told me to take half a pill before and it would make a difference.” This is how many of the stories we hear in the clinic begin: a passing piece of advice, a first try that seems successful, and then a pill without which the night feels incomplete. The question of tramadol and sex deserves a frank answer, because behind it there is often a real problem that the person is embarrassed to bring to a doctor.

Egyptian figures confirm that this link is widespread. In a study conducted at Sohag University and published in 2020 on 76 men with lifelong premature ejaculation, drug tests were positive in 34.2% of them compared with 19.1% of a comparison group without the problem, and tramadol was the most common substance found in the patients, present in 12 of the 26 positive cases. The researchers suggested that use should be asked about when assessing any man who complains of premature ejaculation.

This page does not repeat what the guide on drugs and sex explains about different substances, nor what the page on myths about the benefits of drugs refutes; it focuses on two specific questions: what does research say about tramadol and delayed ejaculation? And what happens when it is combined with Viagra or premature ejaculation medicines?

10What do trials say about tramadol and delaying ejaculation?

Researchers have in fact studied tramadol for premature ejaculation, because it affects serotonin as well as opioid receptors. In a systematic review from the University of Sheffield in the UK published in 2015, eight randomized trials were gathered, and an analysis of four of them involving 721 participants showed that tramadol lengthened the time to ejaculation more than placebo over 8 to 12 weeks. But the researchers described the quality of most trials as unclear, and pointed to wide variation between their results.

More importantly, the same review noted more side effects with tramadol, including erectile dysfunction, constipation, nausea, headache, drowsiness, and dizziness, and stated explicitly that the risk of addiction and breathing difficulties was not assessed in these trials and that its long-term effect in these men is unknown. A more recent review published in 2021, covering nine studies, reached a similar result: improvement in time to ejaculation, with low to moderate quality evidence and no clear determination of the effective dose or duration of treatment.

11Why does a trial result not carry over to a street pill?

Trials are run on selected men after examination, with a licensed medicine, for a set period, with monitoring of side effects. What happens in real life is completely different:

That is why the “pill that makes it last longer” on the street carries all of tramadol's risks without any of the trial's safeguards. The page on tramadol 225 and red tramadol explains why the number printed on smuggled pills cannot be trusted.

12What happens to desire and erections with continued use?

The official tramadol leaflet from the US Food and Drug Administration states that chronic opioid use may affect the hormonal axis between the brain and the testes, leading to a deficiency of male hormones that may show up as low desire, impotence, erectile dysfunction, and infertility, and loss of periods in women. The leaflet explains that the causal role of opioids has not been fully settled because many other factors affect hormones, but the warning stands and is documented in the leaflet.

This combines with what happens psychologically. A man who started with a pill “for occasions” usually goes through successive stages:

1. He notices delayed ejaculation the first few times, and becomes convinced the pill is the solution.
2. The effect weakens with repetition because of tolerance, so he raises the amount or repeats the pill.
3. Anxiety about intimacy without the pill becomes bigger than the original problem.
4. Withdrawal symptoms appear if he is late with it, and use becomes daily.
5. Desire and erections themselves weaken, so he looks for another pill to treat what the first one spoiled.

The page on the harms of tramadol presents the results of Egyptian studies that measured hormones and sexual function in users, so we do not repeat them here.

13Tramadol and Viagra: what happens when they are combined?

Many people confuse the two medicines, although they act on different problems. Sildenafil, the active ingredient in Viagra, increases blood flow to the penis during arousal and so helps with erection, and the US National Library of Medicine (MedlinePlus) explains that it does not cure erectile dysfunction and does not increase sexual desire. Tramadol works in the brain on opioid and serotonin receptors.

A randomized trial conducted at Assiut University and published in 2023 tested combining the two medicines for premature ejaculation in 155 men who completed a 10-week study, and the researchers reported improved ejaculation time and satisfaction with the combination. But it was a small trial supervised by doctors in selected healthy men, and it does not measure long-term dependence. An Egyptian laboratory study on rabbits in 2019 also found that giving tramadol changed sildenafil levels in the blood, a finding in animals whose applicability to humans is unknown, but it is a reminder that combining them is not neutral.

In real life the danger comes from random combining: the US library warns against taking sildenafil with nitrate medicines used by people with angina, and notes that sexual activity itself can strain the heart of someone with heart disease, and that chest pain or dizziness during it calls for stopping and contacting a doctor right away. When pills come from an unknown source and smuggled tramadol is added to them, working out the risk becomes impossible.

14Tramadol with premature ejaculation medicines and antidepressants

This is the most dangerous combination on this subject, because it is common and people do not pay attention to it. Some medicines used for premature ejaculation, such as dapoxetine, and some antidepressants belong to the selective serotonin reuptake inhibitor family. The official tramadol leaflet warns that combining it with these medicines may cause serotonin syndrome, a condition that can be life-threatening, and also raises the risk of seizures. The dapoxetine leaflet approved by the European Medicines Agency says it must not be taken with tramadol, and that one should wait 14 days after stopping tramadol before starting it.

The tramadol leaflet lists these signs of serotonin syndrome:

• Changes in consciousness such as agitation or hallucinations.
• Rapid pulse, unstable blood pressure, and high temperature.
• Tremor and muscle stiffness or involuntary movements.
• Nausea, vomiting, or diarrhea.

Symptoms may begin within hours to days of combining them. If they appear, the right place is the emergency room, not waiting for the effect to “wear off.”

15What is the safe alternative for treating premature ejaculation and erectile dysfunction?

The right start is a visit to an andrology doctor, because premature ejaculation and erectile dysfunction may be caused by diabetes, high blood pressure, a hormonal disorder, anxiety, or a conflict in the relationship. After diagnosis the doctor may choose behavioral or psychological therapy, topical preparations, or a licensed medicine suited to your condition, and these are options the trials themselves compared with tramadol. If anxiety is the main driver, treating it is part of the solution, and it may need assessment as part of a dual diagnosis if there is substance use.

16If intimacy has become tied to tramadol: how do you stop?

If you cannot be intimate without the pill, if the amount has gone up, or if you feel symptoms when you are late taking it, these are signs of dependence. Do not stop suddenly on your own after long use, since the official leaflet warns that abrupt discontinuation in someone who is physically dependent can cause severe withdrawal symptoms. The safe route is a medical assessment and then a plan, which you will find in tramadol addiction treatment, and the page on tramadol withdrawal symptoms explains what you may go through in the first days.

Many men fear that the first weeks after stopping will be worse sexually, and this is possible because of withdrawal, anxiety, and lack of sleep, but it is a temporary phase to be discussed with the doctor and not solved by going back to the pill. Treatment can begin through outpatient treatment in suitable cases, and at Eradah the first consultation is free and confidential.