Pelvic floor exercises and erectile dysfunction

By Kyrylo Lozovyi · August 10, 2026

Most pages on this question either say "yes, kegels cure ED" or nothing at all. The useful version is narrower: there is one good randomised trial, a handful of smaller studies, and a plausible mechanism. Here is all of it, including the part where it does not work.

The mechanism, in one paragraph

An erection is a hydraulic event. Blood flows into two spongy cylinders, the corpora cavernosa, and rigidity depends on keeping it there — the veins that drain them have to be squeezed shut. Two pelvic floor muscles sit directly on those cylinders at the base of the penis: the ischiocavernosus and the bulbospongiosus. When they contract, pressure inside the erectile bodies rises sharply and venous outflow is restricted. This is why the pelvic floor is associated with maintaining rigidity rather than with initiating an erection, and why men whose complaint is "I lose it partway" have more to gain here than men who cannot get an erection at all. That pattern, in detail →

The trial that this all rests on

Grace Dorey and colleagues ran a randomised controlled trial in UK general practice, published in the British Journal of General Practice in 2004 with the follow-up in BJU International in 2005.

At three months, erectile function in the intervention group was significantly better than in the control group (p < 0.001). The controls were then offered the same training.

At six months, on blind assessment:

Two caveats worth stating plainly. It is a single trial with 55 participants, which is enough to be taken seriously and not enough to be definitive. And the intervention included manometric biofeedback — a device that measures the contraction and shows the patient what it is doing — plus supervision by a physiotherapist. An app is not biofeedback. It can count, cue and progress you, but it cannot tell you whether the muscle you just contracted was the right one. That is why the technique checks on the kegel page matter more than any feature in any app.

What came after

The 2025 narrative review of pelvic physical therapy for male sexual disorders in the International Journal of Impotence Research surveys the field since. The overall shape is unchanged: the evidence for pelvic floor muscle training in erectile dysfunction is positive, the trials remain small and methodologically varied, and no one has run the large multi-centre trial that would settle it. In practice that leaves it where the Dorey trial put it — a reasonable, free, side-effect-free first-line option for mild to moderate ED, especially where the complaint is losing rigidity rather than never achieving it.

The part almost nobody says out loud

Erectile dysfunction is frequently a vascular symptom before it is a sexual one. The arteries supplying the penis are narrower than the coronary arteries, so the same atherosclerotic process shows up there first. ED precedes a coronary event by an average of about three years, with a typical range of two to five — a window in which the underlying disease is treatable and silent.

The practical implication: if you have new erectile difficulty and you are over forty, the pelvic floor exercises are fine, and a blood pressure check, a lipid panel and a conversation with a doctor about cardiovascular risk are more important. An app cannot do that part.

When this is the wrong treatment

Pelvic floor training assumes the problem is a weak or poorly-coordinated muscle. Sometimes it isn't:

• Hypertonic pelvic floor. Pain in the perineum, penis or testicles, pain after ejaculation, difficulty starting urination. Strengthening makes it worse.
• Hormonal. Low libido and fatigue arriving together with the ED points at testosterone or thyroid, which is a blood test, not an exercise.
• Medication. SSRIs, beta blockers, finasteride and several others cause ED directly. Worth reviewing before you conclude anything about muscle.
• Psychological. If morning erections and solo erections are normal but partnered ones are not, the mechanism is intact and the problem is anxiety or the relationship. Pelvic floor work does nothing for that; talking therapy does.
• Sudden onset. ED that appeared over days rather than months is unusual and should be looked at.

How to actually do it

The protocol, the technique checks and the progression are on the kegel exercises page. The short version: three sets of eight to twelve squeezes a day, 3–6 second holds, release at least as long as the hold, progressing from lying to sitting to standing, for at least three months.

VitalityRise runs that protocol as timed sessions with a 30-day structure around it. It is a timer and a progression, not a physiotherapist, and it is upfront about the difference.

Sources

• Dorey G, Speakman M, Feneley R, Swinkels A, Dunn C, Ewings P. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract 2004;54(508):819–825.
• Dorey G, Speakman MJ, Feneley RCL, Swinkels A, Dunn CDR. Pelvic floor exercises for erectile dysfunction. BJU Int 2005;96(4):595–597.
• Sahin E, Brand A, Cetindag EN, Messelink B, Yosmaoglu HB. Pelvic physical therapy for male sexual disorders: a narrative review. Int J Impot Res 2025;37:941–949.
• Montorsi F, Briganti A, Salonia A, et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003;44(3):360–364 — the source of the two-to-five-year window.