{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:58:38Z","timestamp":1789052318053,"version":"build-2803163510"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"\n Background<\/jats:title>\n Premature ejaculation (PE) is a common male sexual dysfunction and is frequently accompanied by psychological comorbidities such as anxiety and depression. However, the extent of these mental health burdens across different PE subtypes remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n The aims of this study were to estimate the pooled prevalence of anxiety and depression among men with PE and to compare prevalence patterns across the four established PE subtypes: acquired PE (APE), lifelong PE (LPE), premature\u2010like ejaculatory dysfunction (PLED), and natural variable PE (NVPE).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We systematically searched PubMed, Embase, Web of Science, Cochrane Library, CENTRAL, and Springer databases through July 2025 for observational studies reporting anxiety and\/or depression in PE populations. Pooled prevalence estimates were calculated using random\u2010effects meta\u2010analyses with Freeman\u2013Tukey double-arcsine transformation. Heterogeneity was quantified using\n I<\/jats:italic>\n \u00b2, and subgroup and sensitivity analyses were performed. Instrument-specific subgroup and sensitivity analyses were conducted to address measurement heterogeneity. Publication bias was evaluated using funnel plots and Egger\u2019s regression test.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eighteen studies were included. The pooled prevalence was 42% (95% CI: 25%\u201361%) for anxiety and 41% (95% CI: 27%\u201356%) for depression, with substantial heterogeneity (\n I<\/jats:italic>\n \u00b2 = 99% for both). Egger\u2019s tests did not identify small-study effects, although interpretation is limited by extreme heterogeneity. Subtype patterns were descriptive: APE showed the highest prevalence estimates (anxiety 44.7%; depression 43.0%), whereas NVPE showed the lowest (15.3% and 14.2%). Sensitivity analyses confirmed that no single study materially affected pooled results.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Anxiety and depression are highly prevalent among men with PE, with notable variation across clinical subtypes. These findings underscore the importance of subtype-aware psychological assessment and individualized management in PE care.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n , identifier CRD42024538434.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1694185","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T05:29:42Z","timestamp":1767590982000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence of depression and anxiety with premature ejaculation and its four subtypes: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Sixuan","family":"Che","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukun","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2006.07.004","article-title":"The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking","volume":"51","author":"Porst","year":"2007","journal-title":"Eur Urol"},{"key":"B2","volume-title":"Premature Ejaculation","author":"Crowdis","year":"2025"},{"key":"B3","doi-asserted-by":"publisher","first-page":"qfac015","DOI":"10.1093\/sexmed\/qfac015","article-title":"Premature ejaculation among Chinese urban men: prevalence and correlates","volume":"11","author":"Niu","year":"2023","journal-title":"Sex Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2008.00825.x","article-title":"Impact of premature ejaculation: the psychological, quality of life, and sexual relationship consequences","volume":"5","author":"Rosen","year":"2008","journal-title":"J Sex Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12180","article-title":"Prevalence and factors associated with the complaint of premature ejaculation and the four premature ejaculation syndromes: a large observational study in China","volume":"10","author":"Gao","year":"2013","journal-title":"J Sex Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"100548","DOI":"10.1016\/j.esxm.2022.100548","article-title":"Does bother\/distress contribute to the diagnosis of premature ejaculation","volume":"10","author":"Rowland","year":"2022","journal-title":"Sex Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2010.01975.x","article-title":"International Society for Sexual Medicine\u2019s guidelines for the diagnosis and treatment of premature ejaculation","volume":"7","author":"Althof","year":"2010","journal-title":"J Sex Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2007.01337.x","article-title":"Identification and diagnosis of premature ejaculation","volume":"61","author":"Rosenberg","year":"2007","journal-title":"Int J Clin Pract"},{"key":"B9","doi-asserted-by":"publisher","first-page":"100546","DOI":"10.1016\/j.esxm.2022.100546","article-title":"The tenuous role of distress in the diagnosis of premature ejaculation: A narrative review","volume":"10","author":"Rowland","year":"2022","journal-title":"Sex Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2008.00901.x","article-title":"An evidence-based definition of lifelong premature ejaculation: report of the International Society for Sexual Medicine (ISSM) ad hoc committee for the definition of premature ejaculation","volume":"5","author":"McMahon","year":"2008","journal-title":"J Sex Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1002\/sm2.27","article-title":"An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation","volume":"2","author":"Serefoglu","year":"2014","journal-title":"Sex Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.eururo.2025.04.010","article-title":"European association of urology guidelines on male sexual and reproductive health: 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and peyronie\u2019s disease","volume":"88","author":"Salonia","year":"2025","journal-title":"Eur Urol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1111\/j.1743-6109.2006.00276.x","article-title":"Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part II\u2013proposals for DSM-V and ICD-11","volume":"3","author":"Waldinger","year":"2006","journal-title":"J Sex Med"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2006.00275.x","article-title":"Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part I\u2013validity of DSM-IV-TR","volume":"3","author":"Waldinger","year":"2006","journal-title":"J Sex Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.3390\/diagnostics14161819","article-title":"Comparison of current international guidelines on premature ejaculation: 2024 update","volume":"14","author":"Romano","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/jsxmed\/qdae169","article-title":"Impulse control and its association with ejaculation time in men with premature ejaculation","volume":"22","author":"Saglam","year":"2025","journal-title":"J Sex Med"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.08.035","article-title":"Premature ejaculation: old story, new insights","volume":"104","author":"Jannini","year":"2015","journal-title":"Fertil Steril"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.17324","article-title":"Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: A systematic review and meta-analysis","volume":"316","author":"Rotenstein","year":"2016","journal-title":"JAMA"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.05.026","article-title":"Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"88","author":"Pappa","year":"2020","journal-title":"Brain Behav Immun"},{"key":"B21","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1002\/jrsm.12","article-title":"A basic introduction to fixed-effect and random-effects models for meta-analysis","volume":"1","author":"Borenstein","year":"2010","journal-title":"Res Synth Methods"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"B23","doi-asserted-by":"publisher","first-page":"114511","DOI":"10.1016\/j.psychres.2022.114511","article-title":"Prevalence of depression in older adults: A systematic review and meta-analysis","volume":"311","author":"Hu","year":"2022","journal-title":"Psychiatry Res"},{"key":"B24","first-page":"5","article-title":"Exploring the relationship between depression and erectile dysfunction in aging men","author":"Seidman","year":"2002","journal-title":"J Clin Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1038\/s41443-019-0147-6","article-title":"Lower urinary tract symptoms and depressive symptoms among patients presenting for distressing early ejaculation","volume":"32","author":"Chierigo","year":"2020","journal-title":"Int J Impot Res"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1111\/and.13315","article-title":"Correlations and stratification analysis between premature ejaculation and psychological disorders","volume":"51","author":"Yang","year":"2019","journal-title":"Andrologia"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12123","article-title":"Distribution and factors associated with four premature ejaculation syndromes in outpatients complaining of ejaculating prematurely","volume":"10","author":"Zhang","year":"2013","journal-title":"J Sex Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12383","article-title":"The impact of intravaginal ejaculatory latency time and erectile function on anxiety and depression in the four types of premature ejaculation: a large cross-sectional study in a Chinese population","volume":"11","author":"Gao","year":"2014","journal-title":"J Sex Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2004.04495.x","article-title":"Lifelong premature ejaculation: from authority-based to evidence-based medicine","volume":"93","author":"Waldinger","year":"2004","journal-title":"BJU Int"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1093\/sxmrev\/qeaf016","article-title":"Review of recent data on disorders of ejaculation and orgasm in men: recommendations from the Fifth International Consultation on Sexual Medicine","volume":"13","author":"Shindel","year":"2025","journal-title":"Sex Med Rev"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2021.06.007","article-title":"European association of urology guidelines on sexual and reproductive health-2021 update: male sexual dysfunction","volume":"80","author":"Salonia","year":"2021","journal-title":"Eur Urol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2011.02450.x","article-title":"Neurophysiology of erection and ejaculation","author":"Giuliano","year":"2011","journal-title":"J Sex Med"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2005.05850.x","article-title":"Neurophysiology of the ejaculatory process: developing perspectives","volume":"96","author":"Motofei","year":"2005","journal-title":"BJU Int"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2021.10.010","article-title":"Thalamocortical dysconnectivity in lifelong premature ejaculation: A functional MRI study","volume":"159","author":"Gao","year":"2022","journal-title":"Urology"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0054994","article-title":"A meta-analysis of the effects of the 5-hydroxytryptamine transporter gene-linked promoter region polymorphism on susceptibility to lifelong premature ejaculation","volume":"8","author":"Zhu","year":"2013","journal-title":"PLoS One"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1038\/s41443-023-00768-4","article-title":"Thyroid disorders and male sexual dysfunction","volume":"36","author":"Morenas","year":"2024","journal-title":"Int J Impot Res"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-021-00721-z","article-title":"Thyroid function, sex hormones and sexual function: a Mendelian randomization study","volume":"36","author":"Kjaergaard","year":"2021","journal-title":"Eur J Epidemiol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-022-02348-x","article-title":"Sexual inactivity and dysfunction in Denmark: A project SEXUS study","volume":"51","author":"Andresen","year":"2022","journal-title":"Arch Sex Behav"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1694185\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T05:29:43Z","timestamp":1767590983000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1694185\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":38,"alternative-id":["10.3389\/fpsyt.2025.1694185"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1694185","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]},"article-number":"1694185"}}