Original Research
Sexual Health & Urology

Prevalence of Premature Ejaculation and Erectile Dysfunction and Their Associated Factors Among Urban and Rural Population of Malaysia

Summary

Male sexual dysfunction, encompassing premature ejaculation (PE) and erectile dysfunction (ED), represents a significant but often under-reported public health concern. In Malaysia, a multiethnic and culturally conservative nation, research on sexual health has been limited by social stigma and reluctance to discuss such topics openly. This study addressed this knowledge gap by investigating the prevalence and associated factors of PE and ED in both urban and rural Malaysian populations.

The research employed a cross-sectional design conducted across urban and rural areas using standardised and validated self-administered questionnaires. A total of 319 male participants were recruited for PE screening, with additional assessment of ED using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Associated factors including depression, anxiety, lifestyle behaviours, and sociodemographic characteristics were assessed.

Prevalence Findings

The overall prevalence of PE was 31.7%, which falls within the range reported in international studies (21% to 66%) but represents a significant burden of sexual dysfunction. The most striking finding was the urban-rural disparity: PE prevalence was 20.7% in urban areas compared to 40.8% in rural areas. This nearly two-fold difference suggests that access to healthcare, health education, and potentially differing lifestyle factors between urban and rural settings may contribute to the distribution of sexual health problems.

The higher rural prevalence may reflect several factors, including limited access to sexual health education and counselling, greater reluctance to seek help for sexual problems in rural communities, and potentially different patterns of comorbid psychological conditions. In the broader Malaysian context, where approximately 31.6% of sexually active men report moderate to severe ED according to national survey data, sexual dysfunction represents a substantial public health challenge.

Associated Factors for Premature Ejaculation

The study identified depression, anxiety, and frequent masturbation as factors significantly associated with PE. The relationship between psychological factors and PE is well established in the literature, with anxiety in particular being recognised as both a cause and consequence of PE. In a related Malaysian study using clinical diagnostic criteria, the prevalence of PE was found to be 25%, with ED (OR 3.315) and severe anxiety (OR 7.656) significantly predicting its presence.

The association between frequent masturbation and PE may relate to conditioned ejaculatory patterns, although the direction of causality cannot be established from cross-sectional data. Some clinical hypotheses suggest that habitual rapid ejaculation during masturbation may establish neural pathways that persist during partnered sexual activity.

Factors Associated with Erectile Dysfunction

For ED, infrequent sexual intercourse was the sole factor reaching statistical significance. This finding is consistent with the understanding that sexual activity itself may have a protective effect on erectile function through maintenance of vascular and neural mechanisms. Other studies in Malaysia have identified broader risk factor profiles for ED, including age, diabetes, hypertension, and cardiovascular disease, suggesting that the current study’s smaller sample may have limited power to detect additional associations.

Implications for Public Health

These findings highlight the need for sexual health to be integrated into routine primary care assessment in Malaysia. The high prevalence of PE and ED, combined with known underreporting, suggests that many men are living with untreatable sexual dysfunction that impacts their quality of life and relationships. Given that ED also serves as a sentinel marker for cardiovascular disease in men over 40, routine screening may provide additional opportunities for early detection of cardiometabolic risk factors. The urban-rural disparity underscores the need for targeted sexual health education and accessible treatment services in rural areas.

Limitations

The cross-sectional design precludes causal inference. Self-reported measures of sexual function may be subject to underreporting due to the sensitive nature of the topic. The study sample of 319 men from selected urban and rural areas may not be representative of the broader Malaysian male population. The use of self-administered questionnaires, while enhancing privacy, may introduce literacy-related biases, particularly in rural settings.

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