Epidemiological association between male sexual dysfunction and depression: a systematic review and meta-analysis of observational studies published between 2020 and 2025

Background: Male sexual health and mental health are closely linked, yet a quantitative synthesis of recent evidence is limited. Objectives: This study synthesized observational evidence published between 2020 and 2025 on depressive symptoms among adult men with erectile dysfunction (ED) and on the association between ED and depression; broader male sexual dysfunction evidence was summarized narratively when clinically relevant. Methods: We searched PubMed, EMBASE, Cochrane Library, PsycINFO, and Scopus, and conducted random-effects meta-analyses with prespecified subgroup analyses by measurement instrument. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Results: Eight observational studies (24,563 participants) were included. Among ED samples, pooled depression prevalence was 22.1% (Patient Health Questionnaire-9 (PHQ-9) ≥10; 95% confidence interval (CI): 7.6%–49.5%) and 65.0% (Self-rating Depression Scale (SDS) ≥53; 95% CI: 60.7%–69.0%). Among men with major depressive disorder (MDD), the pooled sexual dysfunction prevalence (Arizona Sexual Experience Scale (ASEX)-defined) was 54.0% (95% CI: 23.2%–82.0%). In a population-based study, ED was associated with approximately two-fold higher odds of depressive symptoms (adjusted odds ratio (aOR) 2.021; 95% CI: 1.797–2.272). In men with MDD, depressive symptom severity correlated strongly with sexual dysfunction severity (r = 0.640). Conclusion: ED and depression frequently co-occur in adult men. Current observational evidence supports integrated screening and collaborative care across urology and mental health services, but causal inferences remain limited. The PROSPERO Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261280261, CRD420261280261.

Erectile dysfunction; Depression; Meta-analysis; Male mental health; Sexual dysfunction; Observational study

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