Prevalence of depression and anxiety with premature ejaculation and its four subtypes: a systematic review and meta-analysis

Background 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. Aims 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‐like ejaculatory dysfunction (PLED), and natural variable PE (NVPE). Methods 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‐effects meta‐analyses with Freeman–Tukey double-arcsine transformation. Heterogeneity was quantified using I ², 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’s regression test. Results Eighteen studies were included. The pooled prevalence was 42% (95% CI: 25%–61%) for anxiety and 41% (95% CI: 27%–56%) for depression, with substantial heterogeneity ( I ² = 99% for both). Egger’s 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. Conclusion 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. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42024538434.