Chronotype is associated with acquired premature ejaculation: evidence from moderated mediation analysis

Acquired premature ejaculation (APE) is a prevalent male sexual dysfunction that significantly impairs quality of life. Although APE is associated with various risk factors, its underlying etiology remains poorly understood.

This research investigates the potential connection between chronotype and APE. Particular emphasis is placed on the mediating associations involving health-promoting lifestyle (HPL) -self-initiated activities that maintain or improve health-and the moderating role of illness perception.

A total of 516 men diagnosed with APE and 495 healthy controls were recruited from our hospital for this study. Participants completed paper-based questionnaires, including sociodemographic information, the Premature Ejaculation Diagnostic Tool, the Health-Promoting Lifestyle Profile II, and the Morningness-Eveningness Questionnaire. Furthermore, patients with APE completed the Brief Illness Perception Questionnaire. Among APE patients, moderated mediation analysis was conducted to explore the underlying mechanisms.

The main finding was that an evening chronotype was associated with both the presence and greater severity of APE, and the association between chronotype and APE severity was partly mediated by HPL and further moderated by illness perception.

Chronotype was associated with the presence of APE (adjusted odds ratio = 0.99, 95% confidence interval [CI], 0.98-1.00, P < .001). Among men with APE, chronotype was associated with APE severity (β = -0.42, P < .01), with HPL mediating this association (β = -0.46, P < .01). Illness perception significantly moderated both the association between chronotype and HPL (β = -0.18, 95% CI, -0.24 to -0.11) and the link between HPL and APE (β = 0.11, 95% CI, 0.03-0.20).

These findings suggest that considering chronotype, HPL, and illness perception may inform clinical approaches to improving ejaculatory regulation in individuals with APE.

This study is the first to investigate the association between chronotype and APE, providing new insights that may inform future clinical considerations. However, the single-center design may limit the generalizability of the results.

Chronotype was associated with both the presence and severity of APE, with the chronotype-severity link partly mediated by HPL and further moderated by illness perception. Integrating chronotype, lifestyle patterns, and illness perception into clinical assessment may improve understanding of ejaculatory control in men with APE.