Prevalence of Sexual Dysfunction with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): An Updated Systematic Review and Meta-Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategy
2.2. Study Selection and Screening
2.3. Data Extraction
2.4. Quality of Studies and Risk of Bias
2.5. Assessment of Certainty in the Body of Evidence
2.6. Statistical Analysis
2.7. Ethical Considerations
3. Results
3.1. Flow of Studies
3.2. Characteristics of Observational Studies Included in Meta-Analysis
3.3. CP/CPPS and Sexual Dysfunction
3.4. CP/CPPS and Premature Ejaculation
3.5. CP/CPPS and Erectile Dysfunction
3.6. Publication Bias
3.7. Study Quality and Risk of Bias
3.8. Certainty of Evidence
4. Discussion
Strengths and Limitations
5. Conclusions
Implications for Future Research and Clinical Practice
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CP | Chronic prostatitis |
CPPS | Chronic Pelvic Pain Syndrome |
EAU | European Association of Urology |
PE | Premature Ejaculation |
ED | Erectile Dysfunction |
MOOSE | Meta-analysis of Observational Studies in Epidemiology |
PICO | Population, Intervention, Comparison, and Outcome |
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PICO Element | Search Terms/Keywords | Variations/Combinations | Example (PubMed) |
---|---|---|---|
P (Population/Participants) | Men | Male, Males | PubMed: “male” [MeSH Terms] OR “men” [Title/Abstract] |
Chronic Prostatitis | Chronic Bacterial Prostatitis, Chronic Pelvic Pain Syndrome, CP/CPPS, Prostatitis-like syndrome | PubMed: “prostatitis” [MeSH Terms] OR “chronic prostatitis” [Title/Abstract] OR “CPPS” [Title/Abstract] | |
I (Intervention/Exposure) | (Not directly applicable for prevalence studies. Focus is on the condition/problem.) | N/A | N/A |
C (Comparison/Control) | (Often not applicable for prevalence studies. Could be men without prostatitis if comparing prevalence rates, but our focus is on men with prostatitis.) | Men without CP/CPPS (if a comparative prevalence is sought) | PubMed: “healthy men” [Title/Abstract] (Use with Population terms if comparing) |
O (Outcome) | Sexual Dysfunction | Erectile Dysfunction, Premature Ejaculation, Ejaculatory Dysfunction, Decreased Libido, Painful Ejaculation, Sexual Problems, Sexual Health, Sexual Function | PubMed: “sexual dysfunction” [MeSH Terms] OR “erectile dysfunction” [MeSH Terms] OR “premature ejaculation” [MeSH Terms] OR “sexual health” [MeSH Terms] |
Scope | Prevalence | Frequency, Occurrence, Epidemiology, Survey, Questionnaire, Cross-sectional | PubMed: “prevalence” [MeSH Terms] OR “epidemiology” [MeSH Terms] OR “survey” [Title/Abstract] |
Author | Year | Country | n | Age | Tools | Outcomes | SD | ED | PE |
---|---|---|---|---|---|---|---|---|---|
Mehik et al., 2001 [31] | 2001 | Finland | 232 | 20–59 | Self-reported | ED | NR | 42.5% | NR |
Tan et al., 2002 [32] | 2002 | Singapore | 859 | 43.14 | NIH-CPSI and IIEF-5 | ED | NR | 52.9% | NR |
Liang et al., 2004 [33] | 2004 | China | 1786 | 20–59 | NIH-CPSI and IIEF-5 | SD and ED | 49.0% | 15.0% | 26.0% |
Hao et al., 2005 [34] | 2005 | China | 2498 | 20–59 | NIH-CPSI and IIEF-5 | SD and ED | 38.0% | 28.3% | NR |
Gonen et al., 2005 [35] | 2005 | Turkey | 66 | 21–55 | NIH-CPSI | PE | NR | NR | 77.3% |
Xue L et al., 2006 [36] | 2006 | China | 432 | 22–45 | NIH-CPSI and IIEF-5 | ED | NR | 25.2% | NR |
Anderson et al., 2006 [37] | 2006 | USA | 146 | 18–77 | NIH-CPSI and PPSS | SD and ED | 92.0% | 31% | NR |
Qiu et al., 2007 [38] | 2007 | China | 623 | 18–57 | CISFPE and IIEF-5 | ED and PE | NR | 16.9% | 39.0% |
Trinchieri et al., 2007 [39] | 2007 | Italy | 399 | <50 | NIH-CPSI | ED and PE | NR | 34% | 55.0% |
Bartoletti et al., 2007 [40] | 2007 | Italy | 764 | 25–50 | NIH-CPSI and IIEF-5 | SD, ED, and PE | 45.5% | 27.5% | 8.4% |
Lee et al., 2008 [41] | 2008 | Malaysia | 296 | 20–69 | NIH-CPSI and IIEF-5 | SD and ED | 72.3% | 48.3% | NR |
Chen et al., 2009 [42] | 2009 | China | 198 | 20–59 | NIH-CPSI and IIEF-5 | ED | NR | 20.7% | NR |
Lan et al., 2009 [43] | 2009 | China | 637 | 25–61 | CISFPE and IIEF-5 | ED and PE | NR | 17.6% | 28.4% |
Rosen et al., 2009 [44] | 2009 | USA | 2301 | 30–79 | NIH-CPSI, IPSS, and IIEF-5 | ED | NR | 32.0% | NR |
Hao et al., 2011 [45] | 2011 | China | 370 | 15–60 | NIH-CPSI and IIEF-5 | ED | NR | 35.1% | NR |
Sonmez et al., 2011 [29] | 2011 | Turkey | 43 | 22–48 | NIH-CPSI and IIEF | SD and ED | 41.9% | 23.3% | NR |
Wang et al., 2013 [46] | 2013 | China | 147 | 18–64 | NIH-CPSI and IIEF-5 | ED | NR | 45.8% | NR |
Cai et al., 2014 [47] | 2014 | Italy | 317 | 33.8 ± 5.1 | NIH-CPSI and PEDT | PE | NR | NR | 37.2% |
Mo et al., 2014 [48] | 2014 | China | 600 | 28.95 ± 4.98 | NIH-CPSI and IIEF-5 | ED and PE | NR | 19.0% | 30.0% |
Lee et al., 2015 [30] | 2015 | Korea | 8261 | 50.4 ± 5.5 | NIH-CPSI and IIEF-5 | PE | NR | NR | 24.2% |
Zhang et al., 2015 [49] | 2015 | China | 2790 | 40.10 ± 0.58 | NIH-CPSI and IIEF-5 | ED | NR | 48.6% | NR |
Zhang et al., 2016 [50] | 2016 | China | 1406 | 32.18 (18–60) | NIH-CPSI and IIEF-5 | ED | NR | 45.4% | NR |
Lee et al., 2021 [51] | 2021 | Republic of Korea | 597 | 50.9 ± 5.6 | NIH-CPSI, PEDT, and IIEF-5 | ED | NR | 89.3% | NR |
Li et al., 2021 [52] | 2021 | China | 461 | 33.86 ± 8.36 | NIH-CPSI, PEDT, and IIEF-6 | ED | NR | 39.5% | NR |
Evans-Durán et al., 2022 [53] | 2022 | Multi-country | 97 | 44.22 ±11.25 | NIH-CPSI and IIEF-5 | ED | NR | 47.4% | NR |
Zhang et al., 2025 [54] | 2025 | USA | 2225 | 40–80 | Self-reported | ED | NR | 27.5% | NR |
Outcome | No. of Studies | Participants | Risk of Bias | Inconsistency (I2) | Indirectness | Imprecision | Publication Bias | Certainty of Evidence |
---|---|---|---|---|---|---|---|---|
Sexual Dysfunction | 6 | 5533 | Serious | Very serious (98%) | Not serious | Serious | Not detected | Very Low |
Erectile Dysfunction | 10 | 13,686 | Serious | Very serious (98%) | Not serious | Not serious | Not detected | Low |
Premature Ejaculation | 24 | 20,127 | Serious | Very serious (99%) | Not serious | Not serious | Not detected | Low |
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Alshahrani, S.; Fathi, B.A.; Abouelgreed, T.A.; El-Metwally, A. Prevalence of Sexual Dysfunction with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): An Updated Systematic Review and Meta-Analysis. Medicina 2025, 61, 1110. https://doi.org/10.3390/medicina61061110
Alshahrani S, Fathi BA, Abouelgreed TA, El-Metwally A. Prevalence of Sexual Dysfunction with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): An Updated Systematic Review and Meta-Analysis. Medicina. 2025; 61(6):1110. https://doi.org/10.3390/medicina61061110
Chicago/Turabian StyleAlshahrani, Saad, Basem A. Fathi, Tamer A. Abouelgreed, and Ashraf El-Metwally. 2025. "Prevalence of Sexual Dysfunction with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): An Updated Systematic Review and Meta-Analysis" Medicina 61, no. 6: 1110. https://doi.org/10.3390/medicina61061110
APA StyleAlshahrani, S., Fathi, B. A., Abouelgreed, T. A., & El-Metwally, A. (2025). Prevalence of Sexual Dysfunction with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): An Updated Systematic Review and Meta-Analysis. Medicina, 61(6), 1110. https://doi.org/10.3390/medicina61061110