Combined on-demand sildenafil citrate and tramadol hydrochloride is an effective and safe treatment for premature ejaculation: A randomized placebo-controlled double-blind clinical trial.

Background: Premature ejaculation (PE) is a common sexual dysfunction that harms both sex partners.

Aim: To evaluate the safety, efficacy and impact on sexual satisfaction scores of the combined use of tramadol HCl and sildenafil citrate for the treatment of PE.

Methods: One hundred and sixty otherwise healthy males complaining of PE (primary/secondary) were enrolled in this randomized, double-blind, placebo-controlled study. Only 155 patients (age range 22-48 years) completed the study. Of them, 81 patients had primary PE, and 74 had secondary PE. The comparative groups included the placebo group ( = 34), sildenafil citrate 50 mg group ( = 39), tramadol HCl 100 mg group ( = 40), and the combination therapy group ( = 42). The treatment duration for all groups was 10 weeks.

Outcomes: This combination is safe and effective.

Results: Five patients discontinued the study, all from the placebo group, due to a lack of improvement over the treatment course. No significant differences were reported between groups before treatment as regards Intravaginal ejaculatory Latency Time (), satisfaction score (), age (), or duration of marriage (). There was a significant improvement in IELT after treatment with a placebo (), associated with an insignificant improvement in satisfaction score (). In the other three groups, there was a significant improvement in IELT after treatment ( for all), which coincided with a significant improvement in satisfaction scores in all three groups ( for all).

Clinical Implications: We recommend this combination in the treatment of premature ejaculation.

Strengths: It is a prospective randomized double-blind placebo-controlled clinical trial.

Limitations: Limited number of participants.

Conclusion: Combined therapy of PE, whether primary or secondary, with sildenafil citrate 50 mg and tramadol HCl 100 mg is safe and effective; and its therapeutic effect is superior to the utilization of either agent alone.