The 'horse trick' for erectile dysfunction is a social media term referring to pelvic floor muscle training (PFMT), specifically exercises targeting the bulbocavernosus and ischiocavernosus muscles at the base of the penis. Whilst the name lacks official clinical recognition, the underlying principle—strengthening pelvic floor musculature to improve erectile rigidity—is supported by evidence from randomised controlled trials. This technique involves a two-phase approach: relaxation of the pelvic floor followed by controlled contraction, similar to stopping urination mid-stream. However, erectile dysfunction has multiple causes, including vascular disease, hormonal imbalances, and psychological factors, so any exercise regimen should form part of a comprehensive treatment plan under professional guidance.

What Is the Horse Trick for Erectile Dysfunction?

The term 'horse trick' for erectile dysfunction is a social media label that has gained attention through online health forums. It describes a pelvic floor exercise technique—the name derives from the muscle engagement pattern, which some compare to the movement a horse makes when flicking its tail. More accurately, this refers to pelvic floor muscle training (PFMT), specifically exercises that involve relaxation (sometimes called a 'reverse Kegel') followed by targeted contraction of the bulbocavernosus and ischiocavernosus muscles—the muscles responsible for maintaining penile rigidity during erection.

The technique involves a two-phase approach: first, men learn to identify and relax the pelvic floor muscles (the 'push out' phase), followed by a controlled contraction that engages the muscles at the base of the penis. This contraction is similar to the action used to stop urination mid-stream or to 'lift' the penis without using hands. Some men report improved erectile rigidity with consistent practice, though these accounts are largely anecdotal.

There is no official clinical terminology called the 'horse trick' in medical literature. However, the underlying principle—strengthening pelvic floor musculature to improve erectile function—is supported by evidence. The technique essentially represents a variation of established PFMT protocols that have been studied in clinical settings.

It is important to note that whilst pelvic floor exercises can be beneficial for some men with erectile dysfunction, they are not a universal solution. Erectile dysfunction has multiple potential causes, including vascular disease, hormonal imbalances, neurological conditions, psychological factors, and medication side effects. Any exercise regimen should be considered as part of a comprehensive approach to managing erectile dysfunction, ideally under guidance from a healthcare professional or a pelvic health physiotherapist. Men with pelvic pain or suspected pelvic floor hypertonicity should seek specialist advice before starting exercises, as over-recruitment of these muscles may worsen symptoms.

Evidence-Based Treatments for Erectile Dysfunction in the UK

In the UK, erectile dysfunction (ED) is common and increases with age. NICE guidelines recommend a stepwise approach to management, beginning with lifestyle modification and progressing to pharmacological interventions when appropriate. First-line treatment typically involves addressing modifiable risk factors and, where suitable, prescribing phosphodiesterase type 5 (PDE5) inhibitors.

PDE5 inhibitors—including sildenafil, tadalafil, vardenafil, and avanafil—work by enhancing the effects of nitric oxide, a natural chemical that relaxes muscles in the penis and increases blood flow during sexual stimulation. Generic sildenafil is widely available on NHS prescription for men with ED. Other PDE5 inhibitors may be prescribed under Selected List Scheme (SLS) criteria, depending on local formulary and clinical circumstances, particularly when the condition causes significant distress or is associated with underlying health conditions such as diabetes, prostate disease, or cardiovascular disorders.

Sildenafil is typically taken 30–60 minutes before sexual activity, whilst tadalafil offers a longer duration of action (up to 36 hours). Sexual stimulation is required for these medications to work. Common side effects include headache, facial flushing, indigestion, nasal congestion, back pain, myalgia, and dizziness. Rare but serious adverse events include sudden visual or hearing loss; men experiencing these should seek immediate medical attention.

Important contraindications and cautions include:

• Contraindicated in men taking nitrate medications for angina (including glyceryl trinitrate) or riociguat (a pulmonary hypertension treatment), and with recreational 'poppers' (alkyl nitrites)

• Caution required in men taking alpha-blockers (risk of hypotension), those with unstable cardiovascular disease, significant hypotension, or recent stroke or myocardial infarction

• Men should be advised to stop the medication and seek urgent medical help if they experience chest pain during sexual activity or an erection lasting more than four hours (priapism)

For men who cannot use or do not respond to PDE5 inhibitors, second-line treatments include:

• Intracavernosal injections (alprostadil) administered directly into the penis

• Intraurethral alprostadil (MUSE) inserted into the urethra

• Vacuum erection devices that draw blood into the penis mechanically

• Testosterone replacement therapy for men with confirmed hypogonadism (low testosterone confirmed on repeat morning testing); testosterone therapy is only indicated when levels are consistently low and requires monitoring of haematocrit and prostate-specific antigen (PSA) as per UK practice. ED may not improve if testosterone levels are normal.

Psychosexual counselling or cognitive behavioural therapy may be recommended when psychological factors contribute to ED. For men with severe ED unresponsive to conservative measures, penile prosthesis surgery may be considered as a last resort. The NHS provides access to specialist erectile dysfunction clinics where urologists and sexual health physicians can offer comprehensive assessment and tailored treatment plans based on individual circumstances and underlying causes.

If you experience side effects from any medication, you can report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Pelvic Floor Exercises and Erectile Function

Pelvic floor muscle training (PFMT) has emerged as an evidence-based, non-pharmacological intervention for erectile dysfunction, particularly for men with weak pelvic floor musculature. Research, including randomised controlled trials, has shown that pelvic floor exercises can improve erectile function in some men with ED when exercises are performed correctly and consistently. Whilst PFMT can be beneficial, the evidence base is smaller than for PDE5 inhibitors, and it is most effective for men with mild to moderate ED where pelvic floor weakness contributes to the condition.

The pelvic floor muscles—particularly the bulbocavernosus and ischiocavernosus—play a crucial role in erectile function. The ischiocavernosus muscles compress the crura of the corpora cavernosa, helping to maintain penile rigidity during erection. The bulbocavernosus muscle surrounds the bulb of the penis and urethra, contributing to the expulsion of residual urine and semen, as well as enhancing erectile rigidity. Weakness in these muscles can result in difficulty achieving or maintaining erections, even when arterial blood flow is adequate.

Performing pelvic floor exercises correctly requires:

• Identification: Locate the muscles by imagining stopping urination mid-stream or preventing the passage of wind. You may try stopping urination once to identify the correct muscles, but do not do this routinely as it may interfere with normal bladder emptying.

• Slow contractions: Tighten the pelvic floor muscles for 5–10 seconds without holding your breath or tensing your buttocks, thighs, or abdomen. Focus on lifting and squeezing the muscles.

• Fast contractions: Perform quick, strong squeezes lasting 1–2 seconds, then release.

• Relaxation: Release completely for 5–10 seconds between contractions.

• Repetition: Aim for 3 sets of 10 slow contractions and 3 sets of 10 fast contractions daily, gradually increasing duration and intensity as strength improves.

Clinical studies suggest that 12 weeks or more of consistent pelvic floor exercises can produce measurable improvements in erectile function for some men. Research has found that a proportion of men with ED regain normal erectile function after several months of supervised pelvic floor training, with others showing significant improvement. The exercises are most effective for men with mild to moderate ED where muscular weakness contributes to the condition, rather than purely arterial insufficiency. If you suspect a specific vascular cause such as venous leak, specialist assessment is required.

Physiotherapists specialising in men's pelvic health can provide personalised instruction to ensure correct technique and optimal outcomes. Guidance from a specialist is particularly important if you experience pelvic pain or suspect pelvic floor hypertonicity, as incorrect exercise may worsen symptoms.

When to Seek Medical Help for Erectile Dysfunction

Men should consult their GP if erectile dysfunction is persistent (occurring regularly for three months or more), causing significant distress, or affecting their relationship. Whilst occasional difficulty with erections is normal and often stress-related, ongoing problems warrant medical evaluation as ED can be an early warning sign of underlying cardiovascular disease, diabetes, or hormonal disorders.

Urgent or emergency medical attention is required if erectile dysfunction:

• Occurs suddenly alongside chest pain, dizziness, or shortness of breath (potential cardiac event—call 999)

• Is accompanied by priapism (erection lasting more than four hours)—this is a medical emergency requiring immediate attendance at A&E

• Follows acute trauma to the genital or pelvic area (seek urgent assessment)

Prompt GP review is advised if erectile dysfunction:

• Is accompanied by painful erections or abnormal penile curvature (possible Peyronie's disease—your GP can arrange urology referral)

• Occurs with other symptoms such as reduced libido, fatigue, or mood changes (possible hormonal disorder)

During a GP consultation, expect a comprehensive assessment including medical history, medication review, lifestyle factors (smoking, alcohol, exercise), and psychological wellbeing. Physical examination may include blood pressure measurement, genital examination, and assessment of secondary sexual characteristics. Blood tests typically screen for diabetes (HbA1c or fasting glucose), lipid profile, and testosterone levels (taken before 11 am when levels are highest). If testosterone is low, a repeat morning sample should be taken on a separate occasion to confirm the result; additional tests such as luteinising hormone (LH), sex hormone-binding globulin (SHBG), and prolactin may be requested when indicated.

Your GP will also assess cardiovascular risk (for example, using the QRISK3 tool), as erectile dysfunction may be an early marker of vascular disease. Optimising cardiovascular risk factors—such as blood pressure, cholesterol, diabetes control, smoking cessation, and physical activity—is an important part of managing ED.

Your GP may also assess for depression and anxiety, as these commonly coexist with ED and can both cause and result from sexual difficulties. The relationship between mental health and erectile function is bidirectional, and addressing psychological factors is often essential for successful treatment.

Referral to specialist services may be appropriate for:

• Men under 40 with persistent ED without obvious cause, or where endocrine, neurological, or post-traumatic factors are suspected

• Complex cases involving multiple comorbidities

• Failure to respond to first-line treatments

• Suspected hormonal, neurological, or anatomical abnormalities

• Relationship or psychological issues requiring psychosexual therapy

Early consultation allows for timely investigation of potentially serious underlying conditions and access to effective treatments. Men should not feel embarrassed—erectile dysfunction is a common medical condition, and GPs are experienced in providing sensitive, confidential care for sexual health concerns.

Frequently Asked Questions