Pelvic Floor Exercises for Premature Ejaculation: What the Study Actually Did

There is one study behind almost every claim you will read about pelvic floor exercises and premature ejaculation. It reported that men went from about 32 seconds to about 146 seconds, and that 82.5% of them regained control. Those numbers are real. What the study actually required of its participants is the part that gets left out.

What did the pelvic floor study actually find?

In 2014 an Italian group published a prospective study of pelvic floor rehabilitation in men with lifelong premature ejaculation. Forty men enrolled and thirty-three completed the twelve-week programme.

Mean ejaculatory latency at baseline was 31.7 seconds, with individual values running from about 17 to 57 seconds. At twelve weeks the mean was 146.2 seconds. Thirty-three of the forty men were described as having gained control of the ejaculatory reflex; five did not respond, and two improved but withdrew.

Taken at face value that is a striking result, roughly a four-and-a-half-fold improvement in a group of men who were, by any definition, severely affected.

What did the protocol actually involve?

This is the part that almost never survives the journey from journal to blog post. The twelve-week programme consisted of three sessions per week, each lasting sixty minutes. Every session was divided into three parts:

• Twenty minutes of physio-kinesiotherapy, supervised, guided muscle training
• Twenty minutes of electrical stimulation of the perineal floor
• Twenty minutes of biofeedback training

That comes to thirty-six hours of supervised clinical treatment, two thirds of which involved equipment you do not have at home. Electrical stimulation and biofeedback are not optional extras in that design. They were two of the three components, and there is no way to tell from this study how much of the benefit came from each part.

When a page tells you that “studies show Kegel exercises can quadruple how long you last,” this is the study being referred to, and that is not what it tested.

Related: All premature ejaculation articles

Why should you not treat it as proof?

There was no control group. This was a single-arm study: everyone got the treatment, and the comparison was to their own starting point. That design cannot separate the treatment from the passage of time, from the effect of twelve weeks of close clinical attention, or from the expectation of improvement. For a condition with a large psychological component, that is a serious gap.

It was small. Forty men enrolled, thirty-three completed. Small single-arm studies systematically produce larger effects than the controlled trials that follow them.

Most of the responders disappeared. Only thirteen of the thirty-three responders, 39%, turned up for the six-month follow-up. Among those who did, mean latency had slipped from 146 seconds to 113 seconds. We have no idea what happened to the other twenty, and the men who stop attending follow-up are not usually the ones doing well.

The authors said all of this themselves. Their published limitations list the small sample, the number lost to follow-up, the short follow-up period and the absence of a second validated questionnaire. They were appropriately careful. The secondary coverage was not.

What do the guidelines say about pelvic floor training?

Pelvic floor training does not appear among the first-line or second-line recommendations in the AUA/SMSNA guideline on disorders of ejaculation. First-line is daily SSRIs, on-demand clomipramine or dapoxetine, and topical anaesthetics. Second-line is on-demand tramadol. The guideline’s position on alternative therapies generally is that the evidence is insufficient.

The 2015 systematic review of behavioural therapies did include pelvic floor rehabilitation among the physical techniques it assessed, and found the results across that whole group mixed: two trials showing large gains against a waiting list, two showing none.

Should you do pelvic floor exercises?

Yes, probably, with the right expectations.

The mechanism is not far-fetched. The pelvic floor muscles are genuinely involved in the ejaculatory reflex, and training a muscle group you have never consciously used is the kind of thing that can plausibly improve control. The exercises cost nothing, take a few minutes a day, carry essentially no risk, and have benefits for continence regardless.

What you should not do is treat them as a substitute for finding out what is going on. If your problem is new rather than lifelong, there may be a specific and reversible cause, see when it is worth talking to a doctor. And if you are considering treatment, the guideline is clear that combining a behavioural approach with medication works better than either on its own.

How do you find the right muscle?

The muscles in question are the ones you would use to stop the flow of urine midstream, or to lift the testicles without moving your legs. Identifying them that way is fine; habitually interrupting urination to exercise them is not recommended.

The usual starting protocol is to contract for a few seconds, release for the same, and repeat ten times, a few times a day, building up as it gets easier. Your abdomen, buttocks and thighs should stay relaxed, if they are working, you are using the wrong muscles.

And if you have not yet established whether you meet the clinical definition at all, start with what counts as premature and what actually helps. The median man lasts about five and a half minutes, which is longer than most men assume.

It is worth being honest that this home version is not what the study tested. If you want the version that was studied, that is a referral to a pelvic floor physiotherapist, and it is a real clinical service rather than a video.

This article is for information only and is not medical advice. It cannot account for your individual circumstances. Talk to a doctor about your own situation, particularly before starting or stopping any prescription medication.