Ferrara shot his first hardcore scene in 1997 during his studies, after answering an ad in a French pornographic magazine. He then started a career as a professional porn actor, appearing in various French and European productions. He chose the stage name Manuel Ferrara because of his passing resemblance to boxer-turned-actor Stéphane Ferrara.

Ferrara became a protégé of Rocco Siffredi, who recommended him for a role in John Stagliano's Fashionistas in which he made his American debut., In 2002, he appeared in blockbuster hit Snoop Dogg's Hustlaz: Diary of a Pimp. In 2003, he started directing gonzo pornography for Platinum X Pictures, a subsidiary of Red Light District Video. In 2004, he began directing for Red Light.

Ferrara married pornographic Actress Dana Vespoli in January 2005. The couple divorced seven years later. They have three sons together. Ferrara also has a daughter with his current partner, pornographic Actress Kayden Kross.

After working for Red Light District for two years, Ferrara began directing for Evil Angel in May 2006. His first Evil Angel film was Evilution, starring Naomi, Melissa Lauren and featuring the comeback of Nici Sterling. Since then, he has directed several porn series, including Fucked on Sight, Slutty & Sluttier, Raw, Evil Anal, Battle of the Sluts, Anal Expedition, Teen Cum Squad, Bangin' Black Boxes, Ass Attack, I'm Your Slut, Mindfuck and New Whores on the Block.

On December 23, 2010, Ferrara appeared alongside Riley Steele in an episode of Manswers titled "Airplane Plane Hanger-On" to discuss their careers for the segment "How Can You Become A Porktastic Porn Star".

In 2012, Ferrara appeared alongside pornographic Actress Zoe Voss in an explicit sex scene for the mainstream film Starlet.

On August 11, 2016, Ferrara joined Twitch.tv, where he hosts and interviews fellow actors and actresses from the adult entertainment industry.