(389) Attachment and Emotion Regulation in Lifelong Premature Ejaculation: A Multicenter, Prospective Study by the Urological Surgery Society’s Andrology Study Group in Turkey

Introduction This study explores the link between lifelong premature ejaculation (PE) and psychosexual dynamic. While the etiology of lifelong PE remains unclear, evidence suggests both genetic and psychological factors-such as anxiety, alexithymia, childhood trauma, and social phobia-may contribute. Attachment theory posits that early parent-child relationships shape adult emotional and sexual functioning. Insecure attachment styles, particularly anxious and avoidant patterns, may play a key role in the development and persistence of lifelong PE. Objective The aim of this study is to examine the relationship between lifelong PE and psychosexual dynamic. Considering the genetic and psychological factors affecting PE, the impact of early life experiences and attachment characteristics on psychosexual functioning will be investigated. This aims to improve the understanding of psychosocial dynamics involved in the development of PE. Methods This prospective cross-sectional study was conducted across 10 centers between 2024 and 2025 with ethical committee approval. Men diagnosed with lifelong premature ejaculation and a control group were evaluated using psychiatric and psychosocial scales, including the Symptom Checklist-90 Revised (SCL-90-R), Experiences in Close Relationships-Relationship Structures (ECR-RS), Difficulties in Emotion Regulation Scale-16 (DERS-16), and Golombok-Rust Sexual Satisfaction Scale (GRISS). Intravaginal ejaculation latency times were measured using a stopwatch. Data analysis involved parametric and non-parametric tests, correlation, and mediation models. All statistical analyses were performed using SPSS software, with p < 0.05 considered statistically significant. Results The study included 2,000 participants (1,000 PE and 1,000 controls). Patients with PE scored significantly higher on all DERS-16 subscales and total score (p < 0.01 for all) and on both ECR-RS dimensions-avoidance and anxiety (p < 0.001)-while scoring lower on GRISS satisfaction (p = 0.002) and ejaculation (p = 0.001) subscales. Correlation analyses showed that insecure attachment was positively associated with emotion regulation difficulties and negatively with sexual satisfaction. Mediation analyses revealed that both avoidance and anxiety indirectly reduced GRISS satisfaction and ejaculation scores through elevated DERS scores, with anxious attachment further exerting significant indirect effects on IELT during intercourse and masturbation, whereas avoidant attachment influenced only intercourse IELT.Anxious attachment significantly affected ejaculation latency during both masturbation and intercourse, with DERS partially mediating these effects. In contrast, avoidant attachment showed a significant indirect effect via DERS only for intercourse latency, but not for masturbation. Conclusions This study is the first to examine emotion regulation as a mediating mechanism between insecure attachment and premature ejaculation (PE). Findings demonstrated that PE is significantly associated with both anxious and avoidant attachment, as well as difficulties in emotion regulation. Mediation analyses revealed that emotion regulation partially explained the effects of insecure attachment on ejaculatory latency, sexual satisfaction, and ejaculation-related scores. These results suggest that lifelong PE is not solely a genital reflex disorder but a psychobiological condition shaped by attachment and regulatory processes. Clinically, interventions targeting only ejaculation control may be insufficient; addressing insecure attachment and enhancing emotion regulation skills may improve outcomes. Limitations include the cross-sectional design, use of a clinical sample, and absence of subdimension analyses. Future longitudinal and multi-group studies are needed. Disclosure No