Objective: To present a systematic review to assess efficacy and safety of tramadol for premature ejaculation.

Methods: A literature search was performed using the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded. Literature reviewed included meta-analyses and randomized and nonrandomized prospective studies. End points included intravaginal ejaculation latency time (in minutes), adverse events, and patient-reported outcome assessments. We used mean difference to measure intravaginal ejaculation latency time and odds ratio to measure adverse events rates. These odds ratios were pooled using a random or fixed effects model and were tested for heterogeneity. We used the Cochrane Collaboration's Review manager (RevMan) 5.1 software for statistical analysis.

Results: We identified 7 publications that strictly met our eligibility criteria. Meta-analysis of extractable data showed that tramadol was associated with a 3-minute intravaginal ejaculation latency time increasing (mean difference 2.77 minutes; 95% CI 1.12-4.47; P = .001) and significantly more patients with adverse events rates compared with placebo (odds ratio 2.89; 95% CI 1.88-4.43; P < .0001). There were no differences between the tramadol and the paroxetine of intravaginal ejaculation latency time (mean difference -0.44; 95% CI -5.07 to 4.18; P = .85). In addition, patients saw significantly greater improvement in patient-reported outcome.

Conclusion: In this diverse population, tramadol is an effective and safety pharmacologic therapy for premature ejaculation.