Decreased gray matter volume of the anterior insular cortex in patients with psychogenic erectile dysfunction: A voxel-based morphometry study.

This study aimed to explore the gray matter morphological alteration and its correlation with the severity of symptoms in patients with psychogenic erectile dysfunction (pED). Fifty patients with pED and 50 healthy controls (HCs) were included. The whole-brain voxel-based morphometry analysis was conducted to compare the differences in gray matter volume (GMV) between patients with pED and HCs. And then, the region-of-interest-based correlation analyses were performed between the GMV of these regions with the most pronounced between-group differences and clinical symptoms in patients. The results demonstrated that patients with pED manifested decreased GMV in the bilateral anterior insula (aINS), bilateral precentral gyrus, left postcentral gyrus, bilateral anterior cingulate cortex, bilateral middle cingulate cortex, bilateral fusiform gyrus, and cerebellum when compared to HCs. Taking the bilateral aINS as the region-of-interest, the results of voxel-based correlation analyses showed that the GMV of the bilateral aINS were positively correlated with the International Index of Erectile Function 5 (IIEF-5) and Quality of Erection Questionnaire score, and the GMV of right aINS was positively associated with duration and sexual craving score in patients with pED. Furthermore, the significant correlations between the total GMV of the right aINS and IIEF-5 and sexual craving score, as well as between the total GMV of the left aINS and sexual craving score were also detected. In conclusion, these results suggested that the decreased GMV of aINS might be a critical neuropathological characteristic of pED, which provided new evidence for understanding the neurobiological basis of pED from the perspective of brain structure alterations.