Central neural mechanisms of lifelong premature ejaculation: a narrative synthesis of neuroimaging and electrophysiological evidence
Abstract
INTRODUCTION: Premature ejaculation (PE) is one of the most prevalent male sexual disorders, with lifelong PE (LPE) affecting ~cx3%-5% of men. While peripheral, psychological, and relational factors are well-known contributing factors, accumulating neuroimaging and electrophysiological evidence suggests central neural mechanisms, including serotonergic, dopaminergic, and other neuromodulatory pathways play a role. OBJECTIVES: To synthesize findings from neuroimaging and electrophysiological (electroencephalography) studies, providing an integrative perspective on the neural substrates of LPE and identifying gaps for future research. METHODS: A narrative review was conducted based on 43 original studies reporting structural-, functional-, and network-level neural correlates of LPE. The literature search and selection were performed in accordance with the Scale for the Assessment of Narrative Review Articles guidelines to ensure transparency and methodological rigor. Studies were categorized by modality, and findings were qualitatively synthesized to identify convergent patterns, regional alterations, and clinical correlations. RESULTS: Structural neuroimaging in LPE patients consistently demonstrates altered gray matter volume, cortical thickness, and white matter microstructure in prefrontal, orbitofrontal, striatal, thalamic, limbic, and temporal regions. Functional analyses reveal reduced top-down inhibitory control from prefrontal regions, hyperconnectivity within…
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