Introduction: Tramadol exhibits an effect profile similar to that of opioid agonists, and tramadol abuse seems to be a problem for a number of countries. The relationship between tramadol and sexual function appears to be controversial. Men with premature ejaculation (PE) may benefit from taking tramadol off label; however, these patients live "on a knife's edge" and are exquisitely sensitive to develop other sexual dysfunctions.
Aim: To review the literature regarding the problem of tramadol abuse and its relationship with sexual function.
Methods: We searched electronic databases from 1977 to September 2015, including PubMed MEDLINE, EMBASE, EBCSO Academic Search Complete, Cochrane Systematic Reviews Database, and GoogleScholar using the following key words: tramadol, sexual functions, and sexual dysfunction.
Main Outcome Measure: To define the supposed benefits and the potential risks of tramadol on different sexual functions including ejaculation, orgasm, erection, desire, and testosterone levels.
Results: Although tramadol is thought to have low abuse and dependence potentials worldwide, its abuse has become a serious problem in many countries, particularly in the Middle East, Africa, and West Asia. The benefit of tramadol in PE was reported in 11 clinical trials, evaluated by 6 systematic reviews, 3 of which pooled data in a meta-analysis. The evidence base on erectile dysfunction, decreased libido, hypogonadism, anorgasmia, and risky sexual behaviors in patients abusing tramadol is inadequate.
Conclusions: Tramadol may offer a useful intervention for treating PE. As all primary studies had suffered from selection, allocation, performance, or assessment bias, additional rigorous well-designed controlled trials are warranted to further investigate the potential long-term risks of tramadol and to determine the safe and the effective minimum daily dose. Clinical research on drug abuse and sexual dysfunction is an emerging field. To date, small numbers of studies have been performed and further studies are warranted.
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