Erectile dysfunction (ED) affects many men and can significantly impact quality of life and relationships. Whilst medication remains a common treatment, pelvic floor muscle training—commonly known as Kegel exercises—offers a non-invasive approach that may help some men improve erectile function. Originally developed for urinary incontinence, these exercises target specific muscles that support penile rigidity during erection. Research suggests that strengthening the pelvic floor may benefit men with certain types of ED, particularly those related to pelvic floor weakness or venous leakage. This article examines how pelvic floor exercises work, the evidence supporting their use, and how they fit within comprehensive ED management.

What Are Pelvic Floor Exercises and How Do They Work?

Pelvic floor muscle training (PFMT), also known as Kegel exercises, involves targeted exercises designed to strengthen the muscles of the pelvic floor. Originally developed by Dr Arnold Kegel in the 1940s for women experiencing urinary incontinence, these exercises have since been recognised as potentially beneficial for men, particularly those experiencing erectile dysfunction (ED) and other pelvic floor disorders.

The pelvic floor comprises a group of muscles that form a supportive sling at the base of the pelvis. In men, these muscles include the bulbospongiosus and ischiocavernosus muscles, which contribute to erectile function. The bulbospongiosus muscle surrounds the base of the penis and may help maintain rigidity during erection by assisting with compression of the dorsal penile vein, potentially restricting venous outflow and helping sustain blood engorgement. The ischiocavernosus muscles may also contribute to maintaining penile rigidity during sexual activity.

When these muscles are weak or poorly coordinated, venous leakage can occur in some men, potentially contributing to difficulty achieving or maintaining an erection. PFMT works by strengthening these specific muscles, improving their tone and endurance. Regular practice may enhance voluntary control over pelvic floor contraction, which could help improve venous occlusion—a mechanism that may underlie some cases of ED.

Additionally, strengthening the pelvic floor may improve pelvic neuromuscular coordination. For men with ED related to pelvic floor weakness, particularly in cases of mild to moderate vascular ED, pelvic floor exercises offer a non-invasive, low-cost intervention that may address underlying muscular factors. Some men with post-prostatectomy issues may also benefit, though evidence is stronger for urinary outcomes than erectile recovery.

How to Perform Pelvic Floor Exercises Correctly for ED

Performing pelvic floor exercises correctly is essential to achieve potential benefit. Many men initially struggle to identify and isolate the correct pelvic floor muscles, so proper technique is crucial.

Identifying the pelvic floor muscles: The easiest way to locate these muscles is to attempt to stop or slow your urine stream midflow (though this should only be done occasionally for identification purposes, not as regular practice). The muscles you engage to do this are your pelvic floor muscles. Alternatively, imagine trying to prevent passing wind—the muscles you tighten are part of the same group. You should feel a lifting sensation at the base of the pelvis without tensing your abdomen, buttocks, or thighs.

Basic pelvic floor exercise technique:

• Contract the pelvic floor muscles by drawing them upward and inward, as if lifting them towards your abdomen

• Hold the contraction for 5–10 seconds while breathing normally

• Relax completely for 5–10 seconds between contractions

• Repeat this cycle 10–15 times per session

• Aim for three sessions daily (morning, afternoon, evening)

• Some protocols also recommend including quick, short contractions alongside the sustained holds

Progression and consistency: Begin with shorter holds (3–5 seconds) if you find longer contractions difficult, gradually increasing duration as strength improves. Consistency is more important than intensity—regular daily practice over weeks to months is necessary to see improvement. Most research suggests a minimum of 8–12 weeks of regular practice before potential benefits emerge.

Common mistakes to avoid: Avoid holding your breath, bearing down (pushing out), or tensing surrounding muscle groups. If you experience pain or worsening symptoms, stop and consult a healthcare professional. Some men benefit from initial guidance from a pelvic health specialist physiotherapist trained in pelvic floor rehabilitation, who can provide biofeedback or manual assessment to ensure correct technique. Men with pelvic pain may require relaxation techniques rather than strengthening exercises.

Evidence and Effectiveness: What Research Shows

The evidence supporting pelvic floor exercises for erectile dysfunction has grown over the past two decades, with several studies suggesting potential benefits, though the overall evidence base remains modest.

A randomised controlled trial published in the BJU International (Dorey et al., 2004) found that 40% of men with ED who performed pelvic floor exercises for six months regained normal erectile function, compared to none in the control group. A further 35% showed improvement. This study specifically targeted men with ED related to pelvic floor weakness and venous leakage, though sample sizes were relatively small.

A systematic review and meta-analysis in the British Journal of Urology International (2019) examined multiple trials and concluded that pelvic floor muscle training showed improvements in erectile function scores, particularly in men with mild to moderate ED. The review noted that combining pelvic floor exercises with lifestyle modifications (such as weight loss, smoking cessation, and increased physical activity) produced better outcomes compared to exercises alone.

The approach appears most promising for specific ED subtypes: men with suspected venous leakage may show better response. There is less evidence supporting effectiveness for psychogenic ED or severe arterial insufficiency, though some men report modest improvements in confidence and sexual function.

Pelvic floor exercises are considered part of conservative management for erectile dysfunction, as noted in clinical resources such as NICE Clinical Knowledge Summaries. The exercises are considered low-risk with no significant adverse effects, making them an appropriate first-line or adjunctive therapy.

However, it is important to note that pelvic floor exercises are not universally effective. Men with severe vascular disease, significant neurological damage, or hormonal deficiencies will likely require additional medical interventions. Response rates vary, and realistic expectations should be set—improvement typically manifests as better rigidity or duration rather than complete resolution in all cases.

Other Treatment Options for Erectile Dysfunction

While pelvic floor exercises offer a non-pharmacological approach, erectile dysfunction often requires a comprehensive treatment strategy tailored to underlying causes and individual circumstances.

Phosphodiesterase-5 (PDE5) inhibitors remain the first-line pharmacological treatment for most men with ED. Medications such as sildenafil (Viagra), tadalafil (Cialis), vardenafil, and avanafil work by enhancing nitric oxide-mediated smooth muscle relaxation in penile blood vessels, facilitating increased blood flow during sexual stimulation. These medications are generally well-tolerated, though common side effects include headache, facial flushing, nasal congestion, dyspepsia, and dizziness. They are contraindicated in men taking nitrate medications or riociguat due to risk of severe hypotension, and caution is needed with alpha-blockers. Recreational nitrates ("poppers") should also be avoided. Always read the Patient Information Leaflet for full safety information. UK clinical guidance recommends PDE5 inhibitors as first-line treatment, with choice guided by patient preference, frequency of sexual activity, and side effect profile.

Lifestyle modifications form an essential component of ED management. Evidence strongly supports:

• Weight loss in overweight or obese men (improves vascular and hormonal function)

• Regular aerobic exercise (150 minutes weekly of moderate-intensity activity)

• Smoking cessation (smoking significantly impairs penile blood flow)

• Alcohol moderation (excessive intake impairs erectile function)

• Mediterranean diet patterns (associated with improved vascular health)

Psychological interventions, including cognitive behavioural therapy (CBT) or psychosexual counselling, benefit men with performance anxiety, relationship difficulties, or psychological contributors to ED. Combined psychological and medical approaches often yield superior outcomes.

Alternative treatments for men who cannot use or do not respond to oral medications include:

• Vacuum erection devices (mechanical devices creating negative pressure)

• Intracavernosal injections (alprostadil injected directly into the penis, requiring training and with risks including priapism, pain and fibrosis)

• Intraurethral alprostadil (medicated pellets inserted into the urethra)

• Penile prosthesis surgery (reserved for refractory cases)

When to seek medical advice: Men experiencing persistent erectile difficulties should consult their GP for proper assessment. ED can be an early marker of cardiovascular disease, diabetes, or hormonal disorders requiring investigation. Your GP can arrange appropriate blood tests (including morning testosterone with repeat if low, glucose, and lipid profiles), assess cardiovascular risk, review medications that may contribute to ED, and discuss treatment options. Urgent medical attention is warranted if ED occurs suddenly, is associated with penile pain or deformity, or follows trauma. Seek immediate medical help for erections lasting more than 4 hours (priapism).

If you experience side effects from any medication, report them through the MHRA Yellow Card scheme.

Frequently Asked Questions