Stimulus-Dependent, Not Resting-State, Neural Dysfunction Underlies the Neurobiology of Delayed Ejaculation: A
1Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Andrology
|April 6, 2026
Summary
Delayed ejaculation (DE) involves stimulus-dependent neural dysregulation, not resting-state issues. Sensorimotor network inhibition and parahippocampal gyrus connectivity disruption are key neurobiological factors in DE.
Area of Science:
- Neuroscience
- Psychiatry
- Sexual Medicine
Background:
- Delayed ejaculation (DE) is a prevalent sexual dysfunction with poorly understood neurobiological underpinnings.
- Limited research has utilized functional magnetic resonance imaging (fMRI) to investigate the neural substrates of DE, particularly using combined resting-state and task-state paradigms.
Purpose of the Study:
- To investigate the neurobiological mechanisms of delayed ejaculation (DE) using resting-state and task-state functional magnetic resonance imaging (fMRI).
- To compare brain activity and functional connectivity between individuals with DE and healthy controls (HCs).
Main Methods:
- Forty-two DE patients and 36 healthy controls (HCs) underwent resting-state and visual sexual stimulation-induced task-state fMRI scans.
- Analysis included regional homogeneity (ReHo), fractional amplitude of low-frequency fluctuations (fALFF), independent component analysis (ICA), and functional connectivity assessments.
- Clinical data, including IIEF-5, GAD-7, PHQ-9 scores, and serum testosterone levels, were collected.
Main Results:
- DE patients exhibited lower serum testosterone, reduced sexual function (IIEF-5), and higher anxiety/depression scores (GAD-7/PHQ-9) compared to HCs.
- No significant resting-state differences in ReHo or fALFF were found between groups.
- During sexual stimulation, DE patients showed sensorimotor network inhibition, while HCs showed activation. ICA revealed disrupted functional connectivity involving the parahippocampal gyrus (PHG) in DE patients.
Conclusions:
- Delayed ejaculation is characterized by stimulus-dependent neural dysregulation rather than intrinsic resting-state abnormalities.
- Inhibition within the sensorimotor network and disrupted PHG-centered functional connectivity represent the neurobiological basis of DE.
- These findings offer potential targets for future clinical interventions for DE.
