Tramadol and sexual dysfunction: the truth behind the performance myth

Does tramadol improve sex? The short answer

No. The link between tramadol and sexual dysfunction runs the opposite way to what many people believe. Tramadol may delay ejaculation in some men at first, but research links repeated use to erection problems, low sexual desire and low testosterone (the main male hormone), and even to poorer sperm quality. Much the same is true of hashish (cannabis), alcohol and stimulants: a short-lived effect that seems helpful, followed by harm that builds up slowly.

If you use tramadol (which some people in Egypt call "tamol") or hashish because you believe it improves your performance, you are not alone, and it doesn't mean you are weak or a bad person. This article calmly explains what the research says, how to get out of this cycle, and when things start to get better.

Where did the myth that drugs improve sexual performance come from?

The myth didn't come from nowhere. Tramadol is a painkiller from the opioid family, and one of its side effects is that it can delay ejaculation. Because of this, some doctors have studied it as a treatment for premature ejaculation, although that same research names the risk of dependence as its biggest concern. From there the idea spread that it "makes sex last longer", and some men started taking it without a prescription or any medical follow-up.

In a study from Tanta University of men dependent on tramadol, published in Interdisciplinary Toxicology in 2019, treating premature ejaculation was the reason for starting in 20% of them, second only to curiosity. And a study from Sohag University, published in Sexual Medicine in 2020, found that tramadol was the substance most often detected in the drug tests of men who had had premature ejaculation since the start of their sexual lives.

So why do people believe the myth? Because the first effect is convincing: the substance may ease anxiety and tension before sex, or give a passing sense of confidence and euphoria. A scientific review published in the Indian Journal of Psychological Medicine in 2014 notes that many people use substances to ease performance anxiety or to get past an existing sexual problem, and that a substance may seem helpful in the short term but harms sexual function in the long run.

What does research say about tramadol and sexual dysfunction?

Opioids, including tramadol, act on the hormonal system that controls how much testosterone the body makes. A review published in the Journal of Endocrinological Investigation in 2018 explains that opioids suppress the signals the brain sends to the testes, so testosterone falls, and this can cause low desire, erectile dysfunction and changes in mood.

Studies from Egypt in particular point to similar findings:

• The Tanta study (2019): erectile dysfunction appeared in 44% of men dependent on tramadol, compared with only 10% in the comparison group, and low sexual desire in 48% compared with 16.7%. Testosterone was lower and the hormone prolactin was higher, and the problems grew the longer tramadol had been used.
• The Benha study (2021): published in the Arab Journal of Urology, it found erectile dysfunction in 41.1% of men dependent on tramadol, compared with 7.9% of healthy volunteers, along with lower testosterone.
• Ejaculation after stopping: in a review of Indian studies published in the Indian Journal of Psychiatry in 2021, studies of men being treated for opioid dependence found that premature ejaculation was more common during periods of abstinence and withdrawal. In other words, the very problem a man started the substance to fix may come back when he stops. That is not a reason to keep using; it is a reason to tell your doctor, so it can be treated safely.

These studies are small, and most of them show a link rather than proving, on their own, that the drug is the cause. But their direction is clear and repeated: ongoing tramadol use doesn't strengthen sexual performance, it is linked to weakening it. If you want to know the signs of dependence itself, read about tramadol addiction signs.

Hashish, alcohol and stimulants: is the picture any different?

Opioids are not the only problem. The other common substances carry much the same short-term promise and the same delayed harm:

• Hashish (cannabis): a systematic review published in Cureus in 2021 found that its clearest link is with more abnormally shaped sperm, while findings on sperm count and movement are conflicting. It also pointed to studies that found erectile dysfunction more common among cannabis users, while cautioning that the evidence is still limited and comes mostly from small studies.
• Alcohol: the 2014 review mentioned above reports that sexual problems in people dependent on alcohol are clearly more common than in healthy comparison groups, most often erectile dysfunction, followed by ejaculation problems and low desire. In women, the review describes vaginal dryness and pain during sex, although research on women is still scarce.
• Stimulants such as cocaine and amphetamines: Cleveland Clinic lists them among the substances that can cause erectile dysfunction, and warns that some of these substances can damage blood vessels in a way that may make the problem permanent.

If hashish is your main worry, you may find this article helpful: Is hashish addictive?

Do drugs cause infertility? Effects on fertility in men and women

Many people ask: do drugs cause infertility in men? The answer is that they can weaken fertility. In the Benha study mentioned above (2021), semen samples from men dependent on tramadol had lower sperm concentration and movement, and a clearly higher share of abnormally shaped sperm, than those of healthy volunteers. On cannabis and sperm quality, the NHS notes that cannabis and cocaine can affect semen quality, and that taking illegal drugs can cause low testosterone.

Women are not spared either. The NHS also says that cannabis and cocaine can affect fertility and make ovulation more difficult, and the 2018 review notes that opioids can make periods irregular or stop them altogether. So if the two of you are planning to have a baby, stopping substances under medical supervision is an important step for both of you, and it helps to tell the doctor about everything each of you uses. If a pregnancy has already started, tell your pregnancy doctor straight away about everything you use, and don't suddenly stop opioids such as tramadol, or sedatives, on your own; do it under their supervision.

The dependence trap: how tramadol damages a marriage

The most dangerous part of the myth isn't only the physical effect, but the cycle it creates. It starts with a pill "just this once" before sex, then it becomes a habit, and then you feel you can't have sex without it. When you try to stop, withdrawal symptoms may appear, and premature ejaculation may return or erections may weaken, so you conclude that the substance is the solution and go back to it.

Over time, the harm spreads to the whole household:

• Fading desire that your partner may take as personal rejection
• Irritability, mood swings and pulling away from conversation and family life
• Hiding, lying and suspicion that wear down trust between husband and wife
• Money problems and pressures that put off having children or make the couple anxious about it
• Shame that stops both partners from asking for help

Does sexual performance come back after stopping drugs?

The good news is that many of these problems can improve. The 2018 review describes the low testosterone caused by opioids as reversible, and notes that stopping may bring testosterone back to normal within about a month in people who had been dependent on heroin. That finding is about heroin specifically, so it doesn't mean everyone will improve at the same pace. Cleveland Clinic describes erectile dysfunction as a very treatable condition.

But honesty matters: improvement isn't immediate for everyone. The 2014 review points out that some sexual problems may continue for a while after stopping in some people, and that this area still needs more research. So be patient with yourself: your body and brain need time to find their balance again, and a doctor can check your hormones and safely treat whatever needs treatment, rather than you trying medicines or hormones on your own. Repairing the marriage itself is part of recovery too; our article on life after recovery explains how to rebuild trust with your wife and family.

When should you get help, and how can you talk to a doctor privately?

Ask for a specialist assessment if:

• You can no longer have sex with your spouse unless you have taken tramadol or another substance
• You have tried to stop and couldn't, or you had withdrawal symptoms
• You need more over time to get the same effect
• You have erection problems, low desire or a delay in having children
• The substance has started causing arguments at home, or problems at work or with money

Talking about sex and drugs is embarrassing for many people, but doctors have heard these questions many times, and their job is to help you, not to judge you. These steps can make it easier:

1. Write it down before the appointment: what you use, for how long, and exactly which problem worries you.
2. Start directly: a sentence like "I've been using tramadol because I thought it would improve sex, and now I have a problem" is enough to open the conversation.
3. Be honest about the details, because they help the doctor choose a safe treatment.
4. Ask about confidentiality if it worries you, and read about confidentiality in addiction treatment.

How does treatment work?

Treatment usually starts with a doctor's appointment, where the doctor assesses which substance you use, for how long, and your physical and mental health. After that, outpatient care and therapy sessions may be enough for some people, while others may need medically supervised detox at the center, followed by a program that works on the anxiety or confidence problems that led to the substance in the first place, including family counseling and follow-up after discharge. A wife or other family members can start by coming alone to learn how to help.

At Oxygen, doctor's appointments, therapy sessions and drug tests are available to men and women aged 15 and over (under 18 with a guardian's consent), while inpatient stays for detox and rehabilitation are for males only. In Egypt you can also call the hotline of the Fund for Drug Control and Treatment of Addiction on 16023, around the clock, for confidential treatment through its partner centers. To reach us or book an appointment: mobile and WhatsApp +20 101 687 0711, or landline +20 45 320 0011.