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You should contact your GP if you experience: New-onset erectile dysfunction after starting tramadol or any other medication Worsening sexual function that affects your quality of life or relationships Complete inability to achieve or maintain erections suitable for sexual activity Associated symptoms such as reduced libido, delayed ejaculation, or inability to reach orgasm Psychological distress related to sexual dysfunction, including anxiety or low mood Seek urgent medical attention for: Erections lasting longer than 4 hours (priapism) Chest pain during sexual activity Painful penile curvature or trauma Sudden neurological symptoms Testicular pain or lumps Your GP will conduct a comprehensive assessment to identify contributing factors