###### Abstract  
Background: Several functional magnetic resonance imaging (fMRI) studies investigated the brain correlates of psychogenic erectile dysfunction (PED) and premature ejaculation (PE), representing the most common sexual dysfunctions in men. These studies allowed a wide set of brain regions in PED and PE patients when compared to healthy men. In the present meta-analysis, we aim at assessing the presence of homogeneity in the cerebral underpinnings of PED and PE. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and after the electronic search, duplicate removal and the application of pre-exclusion criteria, nine PED and ten PE studies were considered eligible with a [PERSON]'s k of 0.84 and 0.75, respectively. The effect sizes of the sociodemographic and psychological/urological dimensions were calculated. We extracted brain clusters from the retrieved studies, comparing patients and controls, and we calculated brain maps with Seed-Based D Mapping software. Results: We found a homogenous involvement of the frontal gyrus and insula in both dysfunctions, suggesting a common network. Conclusions: The anterior insula plays a key role in the processing of emotional features of stimuli, while the posterior insula in interoceptive information is relevant for sexual response. The prefrontal and inferior frontal cortices are important for sexual inhibition/disinhibition. Keywords:fMRI; genital response; psychogenic erectile dysfunction; premature ejaculation; meta-analysis; resting state; effect size; homogeneity map +
Footnote †: journal: Medical and Biotechnological Sciences, University of Porto, 4200-135 Porto, Portugal 1  
Footnote †: journal: Medical and Biotechnological Sciences, University of Porto, 4200-135 Portosmokers [4]. Among the psychosocial factors, relational distress, higher levels of perfectionism, neuroticism, and somatization were considered in PED patients [2]. Other factors are depression and anxiety. According to [PERSON] et al. [5] depression, anxiety, obsessive-compulsive disorder, and psychotic disorders negatively interfere with the erectile response in men [6]. Conversely, PE can be conceived as an ejaculation pattern that occurs approximately one minute after vaginal intercourse without satisfaction for the patient, with a duration of at least 6 months [1; 7]. In Europe, PED prevalence is 19% in Germany, 49% in Spain, and 48% in Portugal [8; 9]. In addition, PE has an occurrence of 31% in Southwest Asia [10], 27% in Korea [11], and 23% in Portugal [12]. Erection and ejaculation showed a closed association during sexual intercourse or masturbation. According to preclinical studies [13], erection and ejaculation are independent events and erection is not a necessary condition for ejaculation. Ejaculation comprises three main phases: emission, expulsion, and organs [14; 15]. Emission and expulsion occur throughout a coordinated process between the central nervous system and the autonomic nervous system at the spinal level [14; 15]. This coordination involves the interplay between dopamine and serotonin that inhibits the sexual response throughout different brain regions [16; 17]. Thus, at different levels, PE and PED negatively affect the sexual response, allowing the patient to have an unsatisfactory sexual experience. More specifically, PE and PED can negatively affect normal sexual inhibitory processes. [PERSON] [18] hypothesized PE as an impulse control disorder (ICD) due to the inability to control ejaculation. Indeed, PE patients have a short latency in intravaginal ejac latency time (IELT) and can avoid sexual intercourse, considered as unsatisfactory due to partner' distress and frustration [19]. In addition, PE symptoms may be secondary to PED [20] suggesting that PE and PED can share a set of mechanisms. Recently, functional magnetic resonance imaging (fMRI) allowed studying the brain correlates underlying of the sexual arousal and sexual inhibition [21; 22; 23].