Hexaplex trunculus (Linnaeus, 1758) is a gonochoric marine gastropod. Previous studies demonstrated that the biocide TBT (tributyltin) induced a sexual abnormality known as imposex (superimposition of male sexual characters onto females) in this whelk. Our study showed imposex in 19 stations out of 20 along the Tunisian coast. The frequency of imposex ranged from 0 to 100%. Among the 19 sites where the condition was found, 8 were considered as highly affected by imposex (VDSI > 3.7), 6 were moderately affected (VDSI > 1.3), and 4 were slightly affected (VDSI > 0). The most affected population was observed in the Bizerta Channel where the highest boating traffic was recorded; no imposex features were found in the Sea of Zarat where boating traffic was very low. Significant differences in imposex levels were obtained among sites with low, moderate, and high boating traffic. All the imposex indices values (I%, RPSI, RPLI, VDSI, FPL, and VDL) were significantly more elevated at sites with high boating traffic compared with sites with low and moderate boating traffic. Malformations of the penis were observed only in five stations and in very low rates, but where imposex rates were high. The incidence of penis malformation in males was significantly related to the boating traffic, I%, and VDSI. However, in females, a correlation was obtained only for the RPLI. The present study provides data on imposex level and penis malformations in H. trunculus from the Tunisian Coast that could be used as a starting point for future monitoring programs and for temporal trend surveillance related to TBT pollution in Tunisia where the use of TBT is not yet banned.