Background: Opioids are effective for chronic pain but can have adverse effects on male sexual function. Objectives: This study aimed to evaluate sexual functions among male tramadol users. Patients and Methods: This case-control study involved 45 male tramadol users and 45 healthy controls. Psychometric tests, such as the International Index of Erectile Function (IIEF), the Sexual Quality of Life Questionnaire-Male Version (SQOL-M), and addiction severity index were given to the participants. They also had clinical interviews and hormonal tests (testosterone, LH, FSH, and prolactin). The primary outcome was erectile dysfunction prevalence. The secondary outcomes included the correlation between ED severity and abuse duration, dosing frequency, addiction severity index, and anxiety and depression scales. Results: Tramadol users had significantly lower total testosterone and LH levels, but higher prolactin compared to controls. Rates of erectile dysfunction were markedly higher in the tramadol group (57.8% vs. 13.3%, p < 0.001). Tramadol users scored significantly worse on the IIEF domains of erectile function, sexual desire, orgasmic function, satisfaction, and preoccupation. Tramadol users also significantly reduced their SQOL-M scores. The duration of use, dosing frequency, and addiction severity index positively correlate with the severity of erectile dysfunction. Conclusion: Extended use of tramadol has been associated with hormonal disruption, an increased prevalence of erectile dysfunction, impairments in various aspects of sexual function, and a reduced quality of sexual life in males.