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Premature ejaculation (PE) accompanied by anxiety or depression is a complex clinical condition at the intersection of male reproductive dysfunction and emotional disorders. Increasing evidence suggests that serotonin (5-HT) and brain-derived neurotrophic factor (BDNF) play central and interrelated roles in its pathogenesis. In this review we examine the bidirectional functions of 5-HT and BDNF in both the reproductive and nervous systems, highlighting their importance in regulating ejaculation, emotional stability, and synaptic plasticity. A comprehensive literature search (2010-2025) was conducted across multiple databases using relevant Medical Subject Headings (MeSH) terms, including pertinent original research and review articles, to synthesize the roles and regulatory pathways of 5-HT and BDNF in PE with comorbid anxiety or depression. We summarize the shared and distinct roles of 5-HT and BDNF in maintaining physiological balance across these systems and focus on their involvement in the major pathological processes underlying PE with anxiety or depression, including neurotransmitter imbalance, neuroendocrine dysregulation, inflammation, and oxidative stress. Furthermore, we outline the related signaling pathways through which 5-HT and BDNF exert their effects and interact. We also evaluate current pharmacological and non-pharmacological interventions targeting these molecules, demonstrating their potential to improve both ejaculatory control and emotional symptoms, and critically appraise selective serotonin reuptake inhibitor (SSRI)-related risks and highlighted the need for individualized dosing and monitoring. Emerging evidence suggests that Traditional Chinese Medicine formulations can extend intravaginal ejaculatory latency and mitigate mood symptoms and may serve as stand-alone or adjunctive options to reduce reliance on selective serotonin reuptake inhibitors (SSRIs). Overall, 5-HT and BDNF are not only deeply involved in the biological mechanisms of PE with comorbid psychological disorders, but also represent promising biomarkers and therapeutic targets, and their integrative neuro-reproductive regulatory functions provide new insights into the diagnosis and treatment of this multifaceted condition. Show less

Premature ejaculation (PE) is one of the most common forms of male sexual dysfunction, yet its underlying neurobiological mechanisms remain unclear. This study aims to explore the role of S100 calcium-binding protein B (S100B) in PE and its regulatory relationship with brain-derived neurotrophic factor (BDNF) and serotonin (5-HT) signaling. A rat model of PE was established using behavioral screening criteria. Sexual behavior parameters were recorded, and the expression levels of S100B, BDNF, and 5-HT in brain tissues were measured using enzyme-linked immunosorbent assay, quantitative real-time PCR, Western blotting, immunohistochemistry, and immunofluorescence. The impact of S100B knockdown on PE-related behaviors and molecular expression was evaluated. The primary outcome was the effect of S100B regulation on PE-related behaviors and its interaction with the BDNF/5-HT signaling pathway. PE rats exhibited classical behavioral features, including shortened ejaculation latency and increased ejaculation frequency. Transcriptomic and protein analyses showed that S100B expression was significantly upregulated, while BDNF and 5-HT levels were markedly reduced in PE rats. S100B expression increased across several brain regions. Knockdown of S100B restored 5-HT and BDNF levels, prolonged ejaculation latency, and alleviated PE behaviors. BDNF overexpression elevated 5-HT levels and improved sexual behavior. Importantly, BDNF silencing reversed the beneficial effects of S100B knockdown, suggesting that S100B regulates ejaculation via the BDNF/5-HT pathway. Targeting S100B and its regulation of the BDNF/5-HT pathway may provide potential therapeutic strategies for managing premature ejaculation. Strengths include comprehensive molecular and behavioral analyses in a rat model provide insights into PE pathophysiology. Although this effect has been demonstrated in animal models, these models may not fully recapitulate the pathophysiological processes of human PE, and further clinical validation is required. Our findings indicate that S100B is upregulated in PE and may contribute to the pathophysiology of PE by modulating the BDNF/5-HT signaling pathway. This study provides a molecular basis for the development of therapeutic strategies targeting PE. Show less