Understanding the Hidden Relationship Between Premature Ejaculation and Erectile Dysfunction

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According to a literature review, premature ejaculation (PE) and erectile dysfunction (ED) were shown to be closely linked, potentially creating a cycle where one condition worsens the other. However, investigators say the exact factors driving this relationship remain unclear and need further examination.

Previous data have suggested that a man’s attempt to control ejaculation may reduce excitement levels and lead to ED, while an effort to maintain an erection can increase arousal, which may culminate in PE. This can result in reciprocal aggravation and the persistence of sexual dysfunction across groups.

“The two situations with each other can lead to a vicious cycle,” wrote a group of investigators including Zhonglin Cai, MD, PhD, associated with the Department of Urology at Gongli Hospital of Shanghai Pudong New Area in Shanghai, China. “Although many studies have explored the relationship between PE and ED, the cause and mechanism are still unknown. … A deeper understanding of the causes and treatments for PE combined with ED will help improve clinical diagnosis and treatment.”

To assess the causes and relationships between PE and ED, focusing on the progression of PE coinciding with high-frequency ED, investigators performed a database search of PubMed, Google Scholar and Web of Science to identify relevant studies published between January 1996 and March 2024.

Research revealed the average prevalence of ED is between 14% and 48%, with 5% to 20% of men experiencing moderate to severe ED. Additionally, the incidence of PE and ED increases with age, with 48% of men over the age of 70 reporting ED symptoms.

Approximately 1 of every 3 patients who experience ED also suffer from PE. Similarly, according to a large-scale survey in the Asia-Pacific region, more than 30% of patients with PE have concomitant ED. These men are also more likely to have similar comorbidities, including lower urinary tract symptoms, diabetes and thyroid disease. According to one study, patients with both PE and ED were younger, had fewer comorbidities and reported less severe ED.

Additionally, psychosocial factors related to these conditions can result in unsatisfactory sexual relationships, affect erectile function and increase sexual stress and anxiety. ED can cause sexual anxiety and tension among those affected, which can cause the occurrence of PE and ejaculation control issues. ED is more likely to develop in addition to PE when PE creates anxiety due to poor sexual performance.

Results of one study highlighted the direct relationship between the risk of PE and ED and anxiety and depression symptoms. This was particularly increased for patients who were not in a stable relationship, while the presence of organic diseases — such as hypertension, diabetes and dyslipidemia — showed the opposite. This led investigators to believe PE related to ED may have more to do with psychological factors than organic ones.

Ultimately, the two conditions do not appear to be categorically separate and should be viewed from a dimensional perspective. Investigators suggest patients maintain a healthy lifestyle, including quitting smoking, to help support sexual function.

“PE combined with ED results in physical and psychological distress to patients, and has a great negative impact on their sexual life and quality of life,” investigators concluded. “At present, a comprehensive treatment approach may be the most effective approach for this condition, but the treatment effect and prognosis still require further research and evaluation to provide better treatment options and improve patients’ prognosis.”