Erectile dysfunction exercises: what helps and what doesn't

Start with the check-up, not the exercises

Before anything else: erection problems deserve a doctor’s visit, even if you plan to handle them yourself.

Mayo Clinic explains why. Erections depend on healthy blood vessels, and so does your heart. The arteries in the penis are small, so when blood vessels start to narrow or stiffen, erections can be affected before you notice anything else. Shared risk factors include high blood pressure, high cholesterol, diabetes, smoking and heavy drinking. Mayo notes that the younger you are, the more likely erection problems are to signal a heart-disease risk.

A doctor can check your blood pressure, blood sugar, cholesterol and hormones, review your medicines (several common ones affect erections), and talk about treatment. Pelvic floor training works alongside that, not instead of it.

How the pelvic floor is involved in erections

Two pelvic floor muscles wrap around the base of the penis:

• Ischiocavernosus — attaches to the base of the penis on each side. When it contracts, it raises the pressure inside the erectile tissue, making the erection firmer.
• Bulbospongiosus — wraps around the bulb of the penis and helps limit blood flowing back out.

The idea behind training is simple: stronger, better-controlled muscles here may help maintain firmness. They can’t fix narrowed arteries, nerve damage or hormone problems — which is why the medical check comes first.

What the Dorey trial found

The best-known study is a randomized controlled trial by Grace Dorey and colleagues, published in 2004.

• Who: 55 men with erectile dysfunction from a urology clinic, median age 59, range 22–78.
• What: 28 men were randomized to pelvic floor exercises plus biofeedback sessions with a physical therapist plus lifestyle advice. 27 men got lifestyle advice only.
• Then: after three months, the lifestyle-only group also moved onto the exercise program.
• Result at six months (blind assessment): 40% had regained normal erectile function, 35.5% had improved, and 24.5% had not improved.

Important caveats, so you know what to expect:

• The program included supervised biofeedback, not just home exercises from a leaflet.
• It was a small trial, run by one research team.
• Around a quarter of men didn’t improve. Pelvic floor training helps some causes of ED more than others.

So: a real, low-risk option that’s worth doing well — and a good reason not to believe anyone who promises guaranteed results.

Should you strengthen or relax first?

Not every man with erection problems needs a stronger pelvic floor. Some have a pelvic floor that’s too tight. Cleveland Clinic lists sexual dysfunction as one of the problems a hypertonic (overly tight) pelvic floor can cause.

Start with relaxation, not kegels, if you have:

• pain in the perineum, testicles, penis or tailbone
• pain during or after ejaculation
• a slow or hesitant stream
• a feeling of constant clenching, or kegels have made things worse

In that case, begin with reverse kegels and read our pelvic pain guide.

How to do the exercises

1. Find the muscles. Squeeze as if you’re stopping gas and stopping your urine stream at the same time. You should feel the base of the penis pull in and the testicles lift slightly. Don’t train by stopping your pee regularly.
2. Slow holds. Squeeze as strongly as you comfortably can, hold for 3–5 seconds, then fully relax for the same time or longer.
3. Quick squeezes. Strong one-second squeezes with a full release in between.
4. Keep everything else relaxed. Buttocks, thighs and belly stay soft. Breathe out as you squeeze; never hold your breath.
5. Train in different positions — lying, sitting and standing — because erections happen in all of them.

A 12-week plan

Weeks	Position	Slow holds	Quick squeezes	Sets a day
1–2	Lying down	10 × 3 s, relax 3–5 s	5	2
3–4	Lying and sitting	10 × 5 s, relax 5 s	10	3
5–8	Sitting and standing	10 × 8 s, relax 8 s	10	3
9–12	Standing; add holds while walking	10 × 10 s, relax 10 s	10	3
12+	Anywhere	Maintain	Maintain	1–2

End every set with three or four slow breaths and a conscious release of the pelvic floor.

Lifestyle matters as much as muscles

The Dorey trial included lifestyle advice for everyone, and for good reason. The things that protect your heart also protect your erections:

• Move most days. Brisk walking, cycling, swimming — anything that gets your heart rate up.
• Stop smoking. It damages blood vessels.
• Keep alcohol moderate.
• Know your numbers: blood pressure, blood sugar and cholesterol.
• Sleep and stress. Anxiety about performance is a common, very real cause of erection problems at any age, especially if you still get morning or solo erections. A doctor or sex therapist can help.

Questions to bring to your doctor

A short list helps you get more out of the appointment:

• Could my erection problems be linked to my heart, blood pressure, blood sugar or cholesterol? Should I have those checked?
• Could any of my medicines be playing a part?
• Should my hormone levels be tested?
• Is this more likely physical, psychological, or a mix?
• Would a pelvic floor physical therapist be useful for me? (In the Dorey trial, biofeedback sessions with a therapist were part of the program.)
• What treatment options fit my health and preferences, and can I combine them with exercises?

It’s also worth mentioning whether you still get morning erections or erections on your own, whether the problem is with getting or keeping an erection, and when it started. That helps your doctor narrow down the cause.

Track your progress

Every couple of weeks, note how long you can hold a good squeeze and how many quick squeezes you can do before they fade. The strength self-test gives you a baseline. Keep a private note on erection quality too — trends over months matter more than any single night.

If you’re three months in with no change, or things are getting worse, go back to your doctor. There are many effective medical treatments, and using one doesn’t mean the exercises were wasted.

Frequently asked questions

Do kegels really help erectile dysfunction?

They can help some men. In the Dorey trial, 55 men with erectile dysfunction were randomized; the exercise group also had biofeedback sessions and lifestyle advice. After six months, 40% had regained normal erectile function, 35.5% had improved and 24.5% hadn't. It's one tool, not a replacement for medical care.

How long do pelvic floor exercises take to help ED?

In the Dorey trial, men trained for three months and were assessed again at six months. Plan on at least three months of regular practice before judging results, and keep seeing your doctor in the meantime.

Is erectile dysfunction a sign of heart disease?

It can be. Mayo Clinic explains that erections and the heart both depend on healthy blood vessels, and the small arteries of the penis can show problems early. The younger you are, the more important it is to get checked.

Can a tight pelvic floor cause erectile problems?

It may play a part for some men, especially those with pelvic pain. Cleveland Clinic notes that an overly tight (hypertonic) pelvic floor can cause sexual dysfunction. If you have pelvic pain or pain after ejaculation, start with relaxation rather than kegels.

Can I do pelvic floor exercises if I'm taking ED medication?

Generally yes — exercises and medication aren't either/or. Many men use both. Ask your doctor what's right for you, and don't stop or change any prescribed treatment without talking to them.

Sources

1. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction (Dorey et al.) — British Journal of General Practice, 2004
2. Pelvic floor exercises for erectile dysfunction (Dorey et al.) — BJU International, 2005
3. Erectile dysfunction: A sign of heart disease? — Mayo Clinic
4. Hypertonic Pelvic Floor — Cleveland Clinic
5. Kegel Exercises — NIDDK

This page is general education about exercise, not a diagnosis or treatment plan. Talk to a clinician about symptoms that are new, severe or getting worse.