The relationship between the severity of erectile dysfunction and the risk of co-occurrence with premature ejaculation: a cross-sectional study.

PURPOSE: This study aimed to investigate the directional relationship and distributional differences between erectile dysfunction (ED) and premature ejaculation (PE) in clinical patients, and to explore whether ED severity predicts the risk of PE comorbidity. METHODS: A cross-sectional, single-center study enrolled 230 men aged 22-45 years with sexual dysfunction (January 2023 - December 2024). ED and PE severity were assessed using the IIEF-5 and CIPE. Patients were classified as PE only (n = 120), ED only (n = 72), or comorbid ED-PE (n = 38). The McNemar test was used to evaluate asymmetry in comorbidity distribution, and comparisons were made across ED severity grades. RESULTS: The prevalence of PE (68.7%) was higher than that of ED (47.8%). There was significant asymmetry: PE alone (n = 120) was more common than ED alone (n = 72); (P = 0.0007). ED severity showed a unidirectional association with PE risk; comorbidity rates increased from mild to moderate ED (22.2% → 42.9%) but plateaued thereafter (severe ED 43.3%). Severe ED had a higher PE risk than mild ED (RR = 1.95, P < 0.05). PE severity did not affect ED prevalence. CONCLUSION: This cross-sectional study suggests an asymmetric association pattern between ED severity and PE risk, most evident during the mild-to-moderate progression. Because of the cross-sectional design, these findings are preliminary and should be interpreted as associations rather than causal relationships. Prospective studies are needed to determine whether early ED progression is a critical risk window for PE. The mild-to-moderate ED group, representing a larger target population with the most pronounced risk escalation, warrants further investigation in future studies.