London - A drug widely used for pain relief could help men suffering from premature ejaculation, say scientists at the University of North Carolina.
Previous small studies have suggested that the drug tramadol can help in this way, but the evidence has been mixed.
Researchers have carried out a meta-analysis, combining the findings from eight studies for a more accurate conclusion, and found that tramadol significantly reduced premature ejaculation.
Reporting in the International Journal of Impotence Research, they say small doses of tramadol two to three hours before sex increased the time between starting sex and orgasm from just 20 to 60 seconds to between three and ten minutes.
Tramadol has been around for nearly 40 years and is used for moderate and severe pain, typically following surgery. It’s one of a class of drugs called opiates, also including codeine, methadone and heroin.
These stimulate opioid receptors in the brain, so the perception of pain is reduced.
Just how tramadol helps with premature ejaculation is unclear, but research suggests it effects the hormones noradrenaline and serotonin and this prolongs ejaculation.
One in four men suffers from premature ejaculation, generally defined as an inability to control orgasm, with it occurring less than one minute after penetration.
In severe cases, the problem can wreck sex lives and marriages.
The cause remains a mystery. Some research suggests it may have a genetic element, with men inheriting the problems from their fathers, but experts also believe it is linked with psychological issues.
One popular theory is that men become conditioned to ejaculate quickly by early sexual behaviour where they do not want to get caught in the act.
Treatments usually involve relaxation techniques or condoms that contain numbing creams. Both aim to reduce sensation to prolong the pleasure. Doctors also sometimes prescribe a type of anti-depressant known as an SSRI. During trials on SSRIs in the late Eighties, extended ejaculation time was one of the reported side-effects.
But even when taken daily, these pills can take up to three weeks to start working. SSRIs can increase the levels of the hormone serotonin, which controls ejaculation without reducing sensitivity in the penis.
A faster-acting SSRI pill, Priligy, was licensed for premature ejaculation in Britain in 2013 and can be taken between one and three hours before sex.
But it is not recommended for all men because it can interfere with other medication and increase side-effects in those with heart, liver or kidney problems.
Tramadol appears to have similar efficacy to Priligy, but may be more suitable for some patients, though the researchers suggest more studies are needed to understand the best dose.
Another concern is that like other opiates, tramadol can be addictive. But while the US researchers conceded there is a small risk, they stressed that taking an occasional low dose made this unlikely. While someone with severe pain might regularly take 300mg doses, for premature ejaculation the dose is 25 to 50mg.
Tramadol prescriptions have doubled in recent years, partly because it is cheap at less than £2 (about R160) for 100 pills, but also because it is seen by some doctors as a safer option than other opiates.
Dr David Goldmeier, a consultant in sexual medicine at St Mary’s Hospital in London, said that while tramadol can be effective, doctors must be careful to target the right patients.
“I do prescribe it, but I am careful to exclude patients with alcohol or drug problems, who could more easily become dependent on tramadol,” he says.
Daily Mail