Background: Recent epidemiological and clinical studies confirmed the presence of a strong association between substance use disorders and sexual dysfunctions. Studies have demonstrated that prevalence of sexual dysfunctions among addict was about 30 %the most common problem among male substance abuse patients were Erectile Dysfunction (ED) and delayed ejaculation Methods: This cohort comparative study was conducted on of 376 males aged between 18 – 50 years who were substance abusers including tramadol, cannabis and poly substance related and addictive disorders. All participants were subjected to psychiatric interview which was done using SCID-5-CV structured clinical interview for DSM-5 disorders. Psychometric, biochemical, medical and drug history evaluations were also performed. Results: Our results show comparison between four groups (opiates-cannabis-poly substance abuse and control group according to severity of drug abuse, psychiatric evaluation and according to sexual functions. There were statistically significant differences between groups in sociodemographic data mainly in occupational and educational history. There also were statistically significant differences between groups in terms of drug use, psychiatric assessment, assessment of sexual activity, hormonal assessment of the studied population and quality of life assessment. Conclusions: Long term drug use has a statistically significant negative effect on all domains of male sexual functions. Also average daily dose and severity of addiction are significantly correlated to sexual dysfunctions in patients with tramadol abuse. This is done through an alteration in sex hormone and alters feedback regulations of the pituitary on the hypothalamus.