Medial Prefrontal Cortex-Amygdala Circuit Involvement in State Anxiety and Psychogenic Erectile Dysfunction: A
Kechong Zhou1, Zewei Kang1, Bin Chen1
1Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei Province, China.
Background:
Erectile dysfunction (ED) and anxiety have a well-documented bidirectional relationship, with anxiety affecting up to 37% of men with ED. While vascular and endocrine mechanisms are well studied, the central nervous system underpinnings linking anxiety to psychogenic ED (pED) remain unclear.
Purpose:
To delineate the neural circuitry through which anxiety potentiates erectile dysfunction.
Study Type:
Retrospective case-control study.
Population:
About 62 male patients (Age: 45.4 ± 12.3) with confirmed pED and 64 age- and education-matched healthy male controls (Age: 46.1 ± 14.7).
Field Strength/Sequence:
3.0 T; T2*-weighted gradient-echo echo-planar imaging sequence.
Assessment:
Task-based fMRI was performed using the Hariri picture-matching task with negative and neutral emotional stimuli; state anxiety was measured with the State-Trait Anxiety Inventory (STAI), and erectile dysfunction severity was assessed using the International Index of Erectile Function (IIEF); all assessments were conducted by trained research staff following standardized protocols.
Statistical Tests:
Whole-brain activation analysis, seed-based Granger causality mapping, and serial mediation analysis were conducted, with significance set at p < 0.05 and family-wise error correction for multiple comparisons.
Results:
pED patients showed significant hypoactivation in the right amygdala and occipital cortex during negative emotion processing. In the pED group, amygdala activation significantly correlated with state anxiety (r = -0.54) and ED severity (r = -0.53). Medial prefrontal cortex (mPFC) was identified as the primary upstream regulator of amygdala activity. Elevated state anxiety showed both direct and indirect statistical associations on erectile function via the mPFC-amygdala pathway.
Conclusion:
Dysfunction of the mPFC-amygdala circuit is associated with the relationship between state anxiety and pED. This circuit represents a novel therapeutic target for pED management.
Stage Of Technical Efficacy:
Stage 3.
