Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in primary versus secondary premature ejaculation: a comparative study

Systemic inflammation has been implicated in male sexual dysfunction, yet data comparing inflammatory markers between premature ejaculation (PE) subtypes—classified as primary premature ejaculation (PPE) or secondary premature ejaculation (SPE)—remain scarce. This study investigated whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) differ between PPE and SPE and could serve as adjunctive biomarkers for clinical classification. This retrospective study included 414 men diagnosed with PE (PPE: n = 200; SPE: n = 214). NLR and PLR were calculated from complete blood counts, and intravaginal ejaculatory latency time (IELT) was recorded. Both NLR and PLR were significantly higher in SPE than PPE (P < 0.001 for both), while IELT was shorter in PPE (P < 0.001). Neither marker correlated with IELT. In multivariable logistic regression, NLR remained independently associated with SPE (odds ratio 1.87, 95% confidence interval 1.40–2.51; P < 0.001), whereas PLR did not. ROC analysis demonstrated moderate discriminative ability for NLR (AUC 0.691; optimal cut-off 1.889; sensitivity 60.3%; specificity 72.5%). Elevated NLR in SPE supports a role for systemic inflammation in acquired PE. NLR may serve as a simple, cost-effective adjunctive marker for differentiating PE subtypes, though prospective validation is warranted.