Associations Between Altered Cerebral Activity Patterns and Psychosocial Disorders in Patients With Psychogenic Erectile Dysfunction: A Mediation Analysis of fMRI

Abstract

Previous studies had illustrated the significant neural pathological changes in patients with psychogenic erectile dysfunction (pED), while few works focused on the neural underpinning of the psychosocial status in patients with pED. This study aimed to investigate the associations among the altered cerebral activity patterns, impaired erectile function, and the disrupted psychosocial status in patients with pED. Thirty-two patients with pED and 28 healthy controls (HCs) were included. The amplitude of low-frequency fluctuations (ALFF), region-of-interest-based functional connectivity (FC), as well as Pearson correlation analyses and mediation analyses between neuroimaging outcomes and clinical outcomes were performed. Compared to HCs, patients with pED manifested lower erectile function, disrupted psychosocial status, as well as decreased ALFF in the left dorsolateral prefrontal cortex (dlPFC) and reduced FC between the left dlPFC and left angular gyrus, and left posterior cingulate cortex (PCC) and precuneus, which belonged to the default mode network (DMN). Moreover, both the ALFF of the left dlPFC and FC between the left dlPFC and left PCC and precuneus were significantly correlated with the sexual function and psychosocial status in patients with pED. The disrupted psychosocial status mediated the influence of atypical FC between dlPFC and DMN on decreased erectile function. This study widened our understanding of the important role of psychosocial disorders in pathological neural changes in patients with pED.

Heart Rate Variability and Erectile Function in Younger Men: A Pilot Study

“…They proposed that this physiological resonance between the two coordinated biological rhythms creates high amplitude oscillations in heart rate that promote functional connectivity in brain regions involved in emotional regulation, such as connectivity between prefrontal cortex, amygdala, insula, and cingulate cortex. In support of this view, patients with psychogenic ED were found to have impaired functional connectivity between prefrontal and posterior cingulate cortices (Cera et al 2014;Yin et al 2020) and impaired functional connectivity between prefrontal cortex and anterior insula (Wang et al 2017). Psychogenic ED patients were also found to have impaired prefrontalamygdala structural connectivity (Chen et al 2018).…”

Convergent and Divergent Structural Connectivity of Brain White Matter Network Between Patients With Erectile Dysfunction and Premature Ejaculation: A Graph Theory Analysis Study

“…The prefrontal cortex is the most complex and highly evolved neocortex region, which accepts different afferent nerve fibers from other brain areas (56,57). The prefrontal cortex was thought to play a central role in the pathophysiology of male sexual dysfunctions in previous functional and structural MRI studies (5,58,59).…”

Altered Regional Homogeneity in Patients With Diabetic Erectile Dysfunction: A Resting-State fMRI Study

“…Altered functional connection patterns of the right dorsolateral prefrontal cortex were found in pED patients, which might also affect the inhibitory control in the sexual context of patients (35). In patients with pED, associations were found between their disrupted psychosocial status and decreased brain activity in the left dorsolateral prefrontal cortex, which suggested that the disrupted psychosocial status mediated the influence of functional connectivity of dorsolateral prefrontal cortex on decreased erectile function (37). In this study, decreased ReHo values were found in the left superior frontal gyrus (dorsolateral) of DM-ED patients.…”

“…The method of rs-fMRI has also been used to explorer the alterations of brain activities in pED (20,(35)(36)(37). Patients with pED were found to have decreased amplitude of low-frequency fluctuations (ALFF measuring the spontaneous activities of brain regions) in the left dorsolateral prefrontal cortex, as well as reduced functional connectivity (FC measuring the synchronization of different brain regions) between the left dorsolateral prefrontal cortex and angular gyrus, and the left posterior cingulate cortex and precuneus (37). Altered activities of the right anterior insula and aberrant connection patterns between the right anterior insula and dorsolateral prefrontal cortex, temporoparietal junction were also found in pED patients (35).…”