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We evaluated the impact of total prostate volume (TPV) on the international index of erectile function-5 (IIEF) and the premature ejaculation diagnostic tool (PEDT). A cross-sectional study was conducted that included 8336 men who had participated in a health examination. PEDT, IIEF and transrectal ultrasonography were used. A full metabolic work-up and serum testosterone level checks were also performed. The median age of participants was 51.0 years. In total, 40.1% had IIEF scores ≤16. Additionally, 24.7% were classified as demonstrating premature ejaculation (PE) (PEDT > 10). The severity of erectile dysfunction (ED) significantly increased with the TPV (ptrend < 0.001). After adjusting for potential confounding factors, the odds ratio (OR) for IIEF scores ≤ 16 significantly increased in the group with TPVs of 30–39 cm3and the group with TPVs ≥ 40 cm3compared with the group with TPVs ≤ 19 cm3(TPV 30–39 cm3, OR: 1.204, 95% confidence interval: 1.034–1.403; TPV ≥ 40 cm3, OR: 1.326: 95% confidence interval: 1.051–1.733) and this relationship was maintained after adjusting for propensity score (TPV ≥ 30 cm3, OR: 1.138: 95% confidence interval: 1.012–1.280). However, neither PEDT nor PE was correlated with TPV. In conclusion, TPV is significantly and independently correlated with IIEF but not with PEDT. Future investigations should explore the temporal relationship between TPV and ED. [ABSTRACT FROM PUBLISHER]