Neural basis underlying the effects of trait and state anxiety on premature ejaculation revealed by resting-state interhemispheric functional connectivity

Abstract

Introduction: Anxiety is considered to play a key role in the development and maintenance of premature ejaculation (PE). In addition, PE patients often co-occur with anxiety, however, the central mechanisms underlying this comorbidity have remained elusive. This study aimed to explore whether trait and state anxiety-related PE shared common or distinct mechanisms in the brain.

Methods: A total of 90 PE patients and 45 healthy controls (HCs) were enrolled. Patients were divided into subgroups including 45 patients with low trait anxiety (LTA) and 45 patients with high trait anxiety (HTA) by state and trait anxiety inventory-trait version (STAI-T). In addition, patients were divided into another two groups including 42 patients with low state anxiety (LSA) and 48 patients with high state anxiety (HSA) by STAI-state version (STAI-S). Magnetic resonance imaging (MRI) data were acquired, preprocessed and the measure of voxel-mirrored homotopic connectivity (VMHC) was calculated and compared between all groups. Moreover, we evaluated whether VMHC of brain regions showed distinct mechanisms between trait and state anxiety-related PE were associated with the severity of PE and anxiety.

Results: Compared with HCs, patients with LTA exhibited increased VMHC in the attention network (AN), default mode network (DMN) and subcortical network (SCN), decreased VMHC in DMN while patients with HTA showed increased VMHC in SCN, decreased VMHC in DMN and AN. Compared with patients with LTA, patients with HTA demonstrated decreased VMHC in DMN and AN. Compared with HCs, patients with LSA had increased VMHC in DMN, decreased VMHC in AN and DMN while patients with HSA exhibited increased VMHC in AN, DMN and SCN, decreased VMHC in DMN, AN and sensory-motor network (SMN). Compared with patients with LSA, patients with HSA demonstrated increased VMHC in DMN. Moreover, premature ejaculation diagnostic tool (PEDT) scores were negatively associated with VMHC of DMN and AN while STAI-T scores were negatively related to VMHC of DMN in patients with HTA. PEDT, STAI-S and STAI-T scores were all negatively associated with VMHC of DMN in patients with HSA.

Conclusion: Our findings demonstrated that decreased interhemispheric functional connectivity (FC) in DMN and AN might be associated with high trait anxiety-related PE while increased interhemispheric FC in DMN might be relate to high state anxiety-related PE. Therefore, trait and state anxiety-related PE might be driven by distinct mechanisms in the brain.

Keywords: Anxiety; Functional magnetic resonance imaging; Premature ejaculation; Resting-state; Voxel-mirrored homotopic connectivity.