(302) Cold Hands, Quick Finish: Peripheral Cold Hypersensitivity Predicts Premature Ejaculation in Men Without Erectile Dysfunction

Introduction Cold hypersensitivity in the hands and feet (CHHF) is a common sensory–autonomic condition characterized by persistent cold sensations in the extremities and heightened sympathetic tone with impaired endothelial reactivity. While CHHF has been associated with vascular and erectile dysfunction, its potential role in premature ejaculation (PE)-a disorder likewise influenced by autonomic hyperexcitability-remains unexplored. Because PE and erectile dysfunction (ED) represent opposite poles of male sexual physiology, studying men without ED offers a unique opportunity to clarify whether CHHF independently contributes to ejaculatory dysregulation. Objective To investigate the association between CHHF and PE in sexually active young men with preserved erectile function, and to determine whether this association remains after adjusting for age, smoking, exercise, and insomnia. Methods A cross-sectional, web-based survey was conducted in December 2022 among Taiwanese men aged 20–40 years. Eligible participants were sexually active within the previous six months, reported normal erectile function (International Index of Erectile Function-5 [IIEF-5] >21), and had no history of phosphodiesterase type-5 inhibitor use. CHHF was defined as self-perceived persistent coldness in both hands and feet during the preceding six months. PE was evaluated using the Premature Ejaculation Diagnostic Tool (PEDT), with scores ≥9 indicating PE. Demographic and lifestyle data-including age, smoking, exercise habits, and insomnia-were collected. Logistic regression analyses were performed to examine associations between CHHF and PE, adjusting for confounders. Results A total of 1,008 participants were analyzed (mean age 31.6 ± 5.2 years); 22.5% reported CHHF. Compared with non-CHHF men, those with CHHF had higher rates of current smoking (21.6% vs. 14.5%, p = 0.018) and insomnia (13.2% vs. 7.0%, p = 0.009). The overall prevalence of PE was 19.8%, and significantly higher among CHHF men (24.7% vs. 18.3%, p = 0.029). In multivariate logistic regression, CHHF remained an independent predictor of PE with an adjusted odds ratio (aOR) of 1.64 (95% confidence interval [CI] 1.00–2.69, p = 0.048), independent of age, smoking, insomnia, and physical activity. Item-level analysis revealed that the PEDT domain “ejaculation occurs too early” was the principal driver of this relationship (OR 2.03, p = 0.011). Sensitivity analyses excluding insomnia or stratifying by exercise status produced consistent results, confirming robustness. Conclusions CHHF independently predicts premature ejaculation among men with normal erectile function, supporting a shared autonomic–vascular dysregulation that links peripheral cold sensitivity with ejaculatory hyperexcitability. This novel finding expands the understanding of male sexual physiology by identifying a potential sensory–autonomic biomarker beyond conventional psychogenic or hormonal pathways. Clinically, self-reported cold extremities-often considered benign-may represent an easily assessable indicator of systemic autonomic imbalance. Recognition of this link encourages integrative strategies targeting endothelial and autonomic health (e.g., aerobic exercise, stress reduction, or biofeedback) as adjunctive approaches in managing premature ejaculation. Disclosure No