Cognitive–emotional pathways linking non-restorative sleep to erectile dysfunction: the role of rumination profiles and resilience

Background Erectile dysfunction (ED) is a prevalent condition that significantly impairs male sexual health and quality of life, yet the psychological pathways—specifically the potential roles of rumination as a mediator and resilience as a moderator—linking it to non-restorative sleep (NRS) remain unclear. To address this, we conducted a cross-sectional study of 880 men with ED recruited from the Andrology Clinic of the First Affiliated Hospital of Anhui Medical University between April 2024 and October 2025. Participants were evaluated using the NRS Scale (NRSS, lower scores indicate more severe NRS), Ruminative Responses Scale (RRS), 10-item Connor–Davidson Resilience Scale (CD-RISC-10), and the 5-item International Index of Erectile Function (IIEF-5); data were subsequently analyzed via Pearson correlations, bootstrapped mediation and moderated mediation modeling, and latent profile analysis (LPA) in Mplus to identify rumination subgroups and characterize variations in erectile function across these profiles. Results NRSS correlated positively with IIEF-5 ( r = 0.63) and negatively with rumination ( r = −0.54). Rumination partially mediated the NRSS–IIEF-5 association (NRSS→rumination: β = −0.54; rumination→IIEF-5: β = −0.22). LPA identified three rumination profiles (low 28.86%, moderate 43.18%, high 27.96%) with graded IIEF-5 scores (high vs low: 8.92±3.84 vs 14.95±5.03). Resilience moderated both the NRSS→rumination path (NRSS × Resilience β = −0.13) and the rumination→IIEF-5 path (Rumination × Resilience β = 0.14), indicating that the indirect association via rumination was conditional on resilience. (All P < 0.001). Conclusion Our findings support a cognitive–emotional pathway wherein subjective sleep non-restoration contributes to ED partially through the mediating role of rumination, while psychological resilience serves to buffer this adverse association. Although longitudinal studies are necessary to establish definitive causal directionality and ensure broader generalizability, these results suggest that integrating therapeutic strategies—specifically those targeting perceived sleep quality, maladaptive rumination, and psychological resilience—may significantly facilitate the development of more personalized and comprehensive clinical management for patients with ED.