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Tramadol For Premature Ejaculation: Can It Help?

Kelly Brown MD, MBA

Reviewed by Kelly Brown MD, MBA

Written by Erica Garza

Published 11/03/2021

Updated 05/25/2024

Can a prescription painkiller kill the pain of premature ejaculation issues?

Tramadol is an opioid painkiller that may help lower the severity of premature ejaculation (PE), the most common male sexual dysfunction, affecting around 30 percent of men worldwide. Though tramadol can offer some relief by delaying orgasm, it does come with a caveat: side effects.

As you explore potential treatments for premature ejaculation (sometimes called early ejaculation), keep reading to find out why tramadol is being prescribed, how the medication affects erectile function, and why you should always be cautious when taking opioid medications. Also learn how tramadol measures up to other analgesic (pain reduction) medications like benzocaine and lidocaine, as well as SSRIs, so you can be sure you’re making the right decision.

Tramadol hydrochloride (tramadol HCL) is a pain medication — or painkiller — typically used to treat moderate to severe pain. It belongs to a class of drugs called opioids, which block pain by binding to receptors in your central nervous system. These drugs are classified as controlled substances.

Tramadol is used for a variety of relief situations, typically for pain experienced outside of a hospital. Your healthcare provider may prescribe this medication if you have pain following surgery or a form of lasting pain from a previous injury. It can also be prescribed for off-label uses like premature ejaculation.

While premature ejaculation and pain management aren’t typically related, tramadol shows promise as a treatment for premature ejaculation. 

However, as an opioid medication, tramadol has significant risks and safety issues that you should be aware of if you’re planning on using it.

Before we get to the side effects, let’s look at what the research says about tramadol’s potential benefits as a premature ejaculation treatment.

Studies on Tramadol for the Treatment of Premature Ejaculation

A few evidence-based, peer-reviewed studies suggest that tramadol helps lower the severity of premature ejaculation and increase intravaginal ejaculatory latency time (IELT) — the time it takes to reach ejaculation during sexual intercourse.

In one randomized, placebo-controlled study published in 2013, researchers compared the effects of tramadol and a non-therapeutic placebo in men between the ages of 18 and 45 with PE. 

Using the stopwatch method, the researchers recorded how quickly it took men to reach orgasm and found men who used 100mg of tramadol on a daily basis for 12 weeks took significantly longer to reach ejaculation, even when tramadol was only used as needed before sex. 

At the start of the study, the men took around 59 seconds time to ejaculation at baseline, but by the end of the study period, they took around 202 to 238 seconds or slightly more than three minutes. In comparison, the men in the placebo group went from an average mean intravaginal ejaculation latency time of just 58.7 seconds prior to treatment to a mean IELT of 94.8 or 96.6 seconds with the placebo treatment.

Not only did the men treated with tramadol show longer sexual endurance and a greater level of ejaculation control — they also reported greater sexual satisfaction. 

Researchers noted that the positive effects of the use of tramadol for the treatment of PE were comparable to other commonly prescribed premature ejaculation treatments, including non-opioid selective serotonin reuptake inhibitors (SSRIs), antidepressants like paroxetine, and dapoxetine. 

A more recent systematic review and meta-analysis published in the journal BMC Urology also looked at the potential benefits of tramadol as a premature ejaculation treatment across eight randomized clinical trials. They found tramadol to be more effective than placebo at delaying ejaculation and increasing the length of sex. And though tramadol appeared to work better than medications like paroxetine and the phosphodiesterase-5 (PDE5) inhibitor sildenafil (Viagra®), tramadol was more likely to cause adverse effects. 

Research on the efficacy of tramadol for on-demand use or as a long-term medication for PE is certainly promising, but it also reveals that tramadol is far from perfect.

It’s also essential to keep in mind that the level of scientific evidence on tramadol and PE is far from totally comprehensive right now, meaning there’s likely still a lot that we don’t know about how tramadol works to treat PE (or whether it’s the best treatment option available). 

Tramadol is available as both a liquid solution and in tablet form, including as long-lasting capsules,  extended-release tablets, and oral drops.

In some cases, tramadol can be taken with or without food. However, it should always be taken exactly as directed by your healthcare professional for your particular needs. 

Since tramadol is used to treat PE in an off-label capacity, there aren’t official dosage recommendations for it. Because of that, it’s important to only use tramadol specifically as prescribed by your healthcare provider.

Stopping tramadol suddenly may cause withdrawal symptoms, including anxiety, panic, sweating, insomnia, nausea, and other potentially severe issues.

Tramadol can — and often does — produce side effects, particularly in the first few weeks of treatment. 

Potential adverse effects of tramadol include:

  • Nausea

  • Headache

  • Nervousness

  • Sleepiness

  • Constipation

  • Vomiting

  • Muscle tightness

  • Changes in mood

  • Uncontrollable shaking

  • Indigestion (heartburn)

  • Dry mouth

Severe side effects are less common and include:

  • Hives

  • Rash

  • Hoarseness

  • Blisters

  • Difficulty swallowing and/or breathing

  • Swelling that affects your face, eyes, throat, tongue, lips, or extremities

  • Hallucinations 

  • Agitation

  • Loss of coordination

  • Loss of appetite

  • Weakness

  • Dizziness

  • Vomiting

  • Changes in heartbeat

It’s important to seek medical attention if you develop any severe or persistent side effects after starting treatment with tramadol. 

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In addition to the undesirable side effects associated with tramadol, there’s also a risk of misuse and addiction. 

Like with other opioids, abuse of tramadol — particularly in the context of long-term treatment — is a major problem both in the United States and around the world. Many people who use drugs like tramadol experience addiction. 

Though tramadol is largely considered to have a low abuse potential compared to most other opioids, the risk of misuse still exists. 

One double-blind, placebo-controlled, crossover trial of on-demand tramadol use found that side effects can be considered tolerable and reversible, but the potential risk of drug dependence is a limiting factor that should not be overlooked. 

Because of its potential for abuse and addiction, some healthcare providers hesitate to prescribe tramadol as a first-line treatment for premature ejaculation, particularly when other medications are available.

If you’re prescribed this medication for PE, your healthcare provider will usually only make this decision if other medications aren’t effective, or if they cause too many unwanted side effects. 

They may also suggest making changes to your habits and lifestyle so that you can use tramadol appropriately, such as limiting your alcohol consumption and avoiding all illicit or recreational drugs, which can increase your risk of harmful side effects or life-threatening overdose. 

Make sure to closely follow your healthcare provider’s instructions and, if needed, inform them as soon as possible if you have concerns about tramadol dependence. 

If tramadol isn’t a recommended first-line treatment for premature ejaculation, what type of treatment will work for you? This is a good question, and it’s one that the medical community is still working to answer. 

Premature ejaculation isn’t yet considered “curable,” but there are numerous options available to help you deal with PE symptoms and improve your sexual stamina and sexual satisfaction.

Behavioral Techniques and Talk Therapy

When it comes to treating PE, the first thing you may think of is taking medication. But it’s not the only option. Techniques you can try at home to help control your erectile function, like the stop-start technique or squeeze technique, are also options. Talk therapy is another if you think psychological factors are causing your PE.

Techniques and Exercises

The stop-start (or start-stop) technique involves simply taking a break from movement when you feel yourself approaching orgasm sooner than you’d like it to, then continuing with intercourse if the urge has faded.

To use the squeeze technique, squeeze the tip of your penis when you feel like you’re about to reach orgasm to help the urge subside.

You might also start doing kegel exercises to strengthen the pelvic floor muscles that you use to pee. Training these muscles can help you control ejaculation urges more effectively while you’re in the act. Some research suggests that pelvic floor muscle training can increase ejaculation time from 30 seconds to more than two minutes.

Talk Therapy

Talking to a therapist can be helpful if you think your PE stems from psychological issues like depression or anxiety. If you’re concerned that you’re struggling with sexual performance anxiety, meeting with a sex therapist might improve your confidence and sexual function. They can help you identify any limiting beliefs contributing to your symptoms or offer tips on physical exercises and techniques like those listed above.

You can also explore sex therapy or couples counseling if PE is affecting your relationship. This kind of therapy allows both partners to speak openly about their needs and problems. It can also help expand your idea of sexuality and the various ways you can be intimate together beyond sex.  

Explore more ways to prevent premature ejaculation.

Over-the-Counter Products and Medications

As for pharmacological options, there are several over-the-counter and prescription options available to help you slow down ejaculation and make sexual behavior more satisfying.

Topical OTC Sprays and Wipes

Over-the-counter options include delay wipes and delay sprays that reduce sensitivity around the tip of your penis, allowing you to avoid feeling overstimulated during sex. These can be applied several minutes before sex, letting you prepare ahead of time for a longer-lasting encounter.

Our Clockstopper Climax Delay Wipes and Delay Spray for Men both contain topical anesthetic ingredients like benzocaine and lidocaine that reduce sensitivity and extend lovemaking, all without making your penis feel too numb or uncomfortable.

Prescription Medications Like SSRIs 

As for prescription PE medications, the most common options are SSRIs, which are approved by the FDA for depression. Along with elevating your mood, these medications can slow down orgasm and ejaculation, allowing you to last for longer in bed with no need for specific techniques or other behavioral modifications.

Two SSRIs that are typically prescribed for premature ejaculation include sertraline (the active ingredient in Zoloft®) and paroxetine (Paxil®). We offer both of these medications online after an evaluation with a licensed healthcare provider. 

For many people, the most effective approach to dealing with PE is a bit of both worlds — a mix of medication and behavioral therapy. Your healthcare provider will let you know what’s best for you and work with you to help you find the most effective treatment for your needs. 

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Like erectile dysfunction and low libido, premature ejaculation is a common problem that can have a debilitating impact on your sexual health and quality of life. 

When it’s severe, it can cause everything from stress to major interpersonal difficulty between you and your sexual partner. But there are treatments that can help. 

If you’re thinking of trying tramadol, premature ejaculation symptoms may improve, but remember this:

  • Tramadol probably shouldn’t be your first choice. Although tramadol does show some promise for the management of premature ejaculation, it usually isn’t recommended as a first-line treatment due to the harmful effects of tramadol misuse.

  • Tramadol side effects are common. Along with a risk of addiction, tramadol side effects include things like nausea, headaches, shaking, nervousness, sleepiness, and indigestion.

  • There are less risky interventions available. Whether you’re dealing with new or lifelong PE, your healthcare provider will likely recommend talk therapy, behavioral techniques, medication, or a mix of different approaches to improve your erectile function.

Interested in learning more about treating PE? Explore our premature ejaculation treatments, including delay wipes, topical sprays, and prescription medications for dealing with early ejaculation. 

You can get started by participating in an online premature ejaculation consultation.  

After a quick questionnaire, you’ll connect with a licensed healthcare provider, who will determine if medication is appropriate. 

Have you been dealing with premature ejaculation for a long time? You’re not alone. Check out this blog on Lifelong Premature Ejaculation for more resources. 

11 Sources

  1. Crowdis M, Leslie SW, Nazir S. Premature Ejaculation. (2023, May 30). StatPearls. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK546701/
  2. Eassa, B. I., & El-Shazly, M. A. (2013). Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation. Asian journal of andrology, 15(1), 138–142. https://doi.org/10.1038/aja.2012.96
  3. Kurkar, A., Elderwy, A. A., Abulsorour, S., Awad, S. M., Safwat, A. S., & Altaher, A. (2015). A randomized, double-blind, placebo-controlled, crossover trial of "on-demand" tramadol for treatment of premature ejaculation. Urology annals, 7(2), 205–210. https://doi.org/10.4103/0974-7796.150481
  4. Tramadol. (2022, January 15). Retrieved from https://medlineplus.gov/druginfo/meds/a695011.html
  5. Dhesi, M., Maldonado, K.A. & Maani, C.V. (2022, June 6). Tramadol. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537060/
  6. Dhesi, M., Maldonado, K.A. & Maani, C.V. (2022, June 6). Tramadol. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537060/
  7. Khan, A.H. & Rasaily, D. (2013). Tramadol Use in Premature Ejaculation: Daily Versus Sporadic Treatment. Indian Journal of Psychological Medicine. 35 (3), 256-259. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821202/
  8. Martyn-St James, M., et al. (2015). Tramadol for premature ejaculation: a systematic review and meta-analysis. BMC Urology. 15, 6. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25636495/
  9. Eassa, B.I. & El-Shazly, M.A. (2013, January). Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation. Asian Journal of Andrology. 15 (1), 138-142. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739134/
  10. Premature ejaculation: What can I do on my own? (2019, September 12). InformedHealth.org. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547551/
  11. Chu, A. & Wadhwa, R. (2022, May 8). Selective Serotonin Reuptake Inhibitors. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown MD, MBA

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown is a founding member of Posterity Health where she is Medical Director and leads strategy and design of their Digital Health Platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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