Ashour won his first major international title in 2004 at the age of 16, becoming the youngest player ever to win the Men's World Junior Squash Championship.

[1] In July 2006, he became the first player in history to win the World Junior Championships for the second time, defeating fellow Egyptian Omar Mosaad.

[1] In the same year he transitioned out of the junior division, Ashour reached his first major final at the Cathay Pacific Swiss Privilege Hong Kong Squash Open in 2006, where he lost to fellow Egyptian, Amr Shabana, who later would attain the number one ranking in the world.

In April 2007, Ashour won the Kuwait Open, the richest squash event in the world, by defeating Amr Shabana, 11–5, 11–3, 12–10, in 34 minutes, after facing a 10-6 deficit in the third set.

Also in 2007, Ashour was invited to the ATCO World Series Squash Finals event, where he competed against the other seven top points earners of the season.

According to squash legend and writer Malcolm Willstrop, "Ramy Ashour is something else — his movement is better than anyone in the game, and allied to his unique racket skills and vision, he lights up the sport.

A month later, Ashour played in a PSA World Series final at the North American Open in Virginia, losing to Matthew in a five-game match.

The rivalry between the Egyptian and the Englishman continued when both played for their country in the WSF 2011 Men's World Team Squash Championships in Paderborn, Germany.

Ashour furthered his attempt toward reclaiming his world number one ranking by defeating Matthew once more at the 2011 Rowe British Grand Prix, winning the match 3 games to 1.

After coming back from a long injury break in February 2012, Ashour made the final at the North American Open 2012, where he lost to the new world number one, James Willstrop.

At the El Gouna International in April, Ashour won their rematch, collecting another major title in front of his home crowd after Willstrop pulled out of the final in the third game.

At the Allam British Open in May, Ashour missed the opportunity to be the first Egyptian title holder, after Abou Taleb in 1966, by losing to his old rival and defending champion Matthew.

It almost certainly had an impact on his trophy cabinet, but Ashour himself took a characteristically philosophical approach to his injury, demonstrated in his various social media posts on the issue - citing his mental battle and desire for a full recovery.