Background　The　striatum　has　been　reported　to　be　implicated　in　various　neurological　diseases,　including　lifelong　premature　ejaculation　(LPE).　Altered　striatum-related　functional　connectivity　was　investigated　in　LPE　patients　in　previous　studies;　however,　structural　abnormalities　in　the　striatum　have　been　less　studied　in　LPE.　Purpose　To　identify　the　gray　matter　volume　(GMV)　and　structural　covariance　patterns　of　the　striatum　between　LPE　patients　and　healthy　controls　(HCs).　Study　Type　Prospective.　Subjects　Forty-three　LPE　patients　and　31　male　HCs.　Field　Strength/Sequence　3.0　T　magnetic　resonance　imaging　(MRI)　scanner;　T1-weighted　imaging　using　a　spoiled　gradient　recalled　echo　sequence.　Assessment　Preprocessing　of　structural　MRI　data　and　the　striatum-seeded　GMV　computation　were　conducted　using　SPM12.　Statistical　Tests　Two　sample　t-test　was　used　to　compare　differences　in　GMV　of　the　striatum　between　patients　and　HCs.　Regions　showing　altered　between-group　GMV　were　considered　as　seeds　for　structural　covariance　analysis　in　two　groups.　Additionally,　correlations　between　GMV　findings　and　clinical　features　were　assessed　with　age　and　total　intracranial　volume　(TIV)　as　covariates　and　with　age,　TIV,　anxiety,　and　depression　scores　as　covariates　in　the　patient　group,　P　＜　0.05　was　considered　statistically　significant.　Results　Compared　to　HCs,　LPE　patients　had　significantly　decreased　GMV　in　four　regions　located　in　the　bilateral　caudate　and　putamen.　Distinct　striatum-based　structural　covariance　patterns　in　the　two　groups　were　mainly　related　to　the　thalamus,　amygdala,　insula,　anterior　cingulate　cortex,　middle　cingulate　cortex,　medial　prefrontal　cortex,　primary　motor　cortex,　and　precuneus/cuneus.　LPE　patients　showed　that　GMV　in　the　bilateral　caudate　negatively　correlated　with　the　premature　ejaculation　diagnostic　tool　(PEDT)　scores　(r　=　-0.369,　r　=　-0.377,　respectively).　Data　Conclusion　Our　findings　indicated　that　LPE　patients　had　altered　GMV　and　structural　covariance　patterns　in　the　striatum　compared　to　HCs.　The　correlations　between　abnormal　GMV　and　PEDT　were　also　shown　in　the　present　findings.　These　findings　may　contribute　to　enhancing　the　understanding　of　the　pathophysiology　of　LPE.　Level　of　Evidence　1　Technical　Efficacy　Stage　3