Here we have investigated the association between tramadol abuse and male sexual function. Methods Eighty-two male tramadol abuse patients and 55 healthy controls (20- to 45-years-old) were included in the study. Data from a sociodemographic questionnaire and the International Index of Erectile Function Questionnaire were collected and analyzed. Results The tramadol abuse patients were 5 times more likely than their healthy counterparts to have erectile dysfunction. The tramadol abuse patients also had worse scores in the orgasmic, sexual desire, intercourse satisfaction, and overall satisfaction domains compared to the controls. Conclusion Sexual dysfunctions are common among tramadol abuse patient