Medial Prefrontal Cortex–Amygdala Circuit Involvement in State Anxiety and Psychogenic Erectile Dysfunction: A Task‐Based fMRI Study

Background Erectile dysfunction (ED) and anxiety have a well‐documented bidirectional relationship, with anxiety affecting up to 37% of men with ED. While vascular and endocrine mechanisms are well studied, the central nervous system underpinnings linking anxiety to psychogenic ED (pED) remain unclear. Purpose To delineate the neural circuitry through which anxiety potentiates erectile dysfunction. Study Type Retrospective case–control study. Population About 62 male patients (Age: 45.4 ± 12.3) with confirmed pED and 64 age‐ and education‐matched healthy male controls (Age: 46.1 ± 14.7). Field Strength/Sequence 3.0 T; T2*‐weighted gradient‐echo echo‐planar imaging sequence. Assessment Task‐based fMRI was performed using the Hariri picture‐matching task with negative and neutral emotional stimuli; state anxiety was measured with the State–Trait Anxiety Inventory (STAI), and erectile dysfunction severity was assessed using the International Index of Erectile Function (IIEF); all assessments were conducted by trained research staff following standardized protocols. Statistical Tests Whole‐brain activation analysis, seed‐based Granger causality mapping, and serial mediation analysis were conducted, with significance set at p < 0.05 and family‐wise error correction for multiple comparisons. Results pED patients showed significant hypoactivation in the right amygdala and occipital cortex during negative emotion processing. In the pED group, amygdala activation significantly correlated with state anxiety (r = −0.54) and ED severity (r = −0.53). Medial prefrontal cortex (mPFC) was identified as the primary upstream regulator of amygdala activity. Elevated state anxiety showed both direct and indirect statistical associations on erectile function via the mPFC‐amygdala pathway. Conclusion Dysfunction of the mPFC–amygdala circuit is associated with the relationship between state anxiety and pED. This circuit represents a novel therapeutic target for pED management. Level of Evidence 3. Stage of Technical Efficacy Stage 3.