Severity of erectile dysfunction and premature ejaculation positively correlate with aggression levels in men: insights from a large population-representative study

Abstract

The effects of erectile dysfunction (ED) and premature ejaculation (PE) on men’s mental health are well-studied, but their link to aggression has been less explored. Thus, we measured associations between ED, PE, and aggression of men in a large representative cohort with well-balanced demographic characteristics. Participants completed computer-assisted web interviews with reliable questionnaires to assess ED, PE, and aggression. These included the five-item International Index of Erectile Function (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the Aggression Module of the Hospital Anxiety and Depression Scale-Modified Version (A-HADS-M). A representative sample of adult men was generated based on the most recent census data, incorporating age and place of residence as quota controls, along with sample size calculations. We interviewed 3001 men, with a mean IIEF-5 score of 18.92 ± 5.04, a mean PEDT score of 7.15 ± 4.26, and a mean A-HADS-M score of 2.71 ± 1.64. We found that aggression was more prevalent in those with ED or PE (p < 0.001). The greater the severity of ED and PE, the greater was the intensity of aggression (Spearman’s rank correlation coefficients of −0.207, p < 0.001 and 0.19, p < 0.001 for ED and PE, respectively). Univariate regression models showed significant links between aggression and both ED and PE across age groups. Multivariate models confirmed that these associations were significant and independent of age, sociodemographic factors, comorbidities, and lifestyle habits (regression coefficients: −0.041, p < 0.001 for ED and 0.028, p < 0.001 for PE). Our findings convincingly demonstrated a consistent association between aggression, ED, and PE, warranting further investigation into the underlying mechanisms of these relationships.