If you’ve Googled “how to last longer in bed,” you’ve been told to do kegels. Every men’s health article, every Reddit thread, every urologist — kegels, kegels, kegels.
The advice sounds evidence-based. People cite studies. Systematic reviews exist. It feels scientific.
But when you actually read the papers — not the abstracts, the full methodology — the picture gets murkier. I’m not saying kegels never help anyone. I’m saying the evidence is weaker and more complicated than the confident recommendations suggest.
Let me walk you through what I found.
The Systematic Review That Started My Skepticism
In 2019, Myers & Smith published a systematic review in Physiotherapy titled “Pelvic floor muscle training improves erectile dysfunction and premature ejaculation.” Sounds authoritative. Systematic reviews are the gold standard — researchers collect every relevant study, assess quality, and synthesize findings.
For PE specifically, they identified five studies.
That’s the entire published literature on pelvic floor training for premature ejaculation as of 2019. Five studies.
The review itself is refreshingly honest about the limitations:
“The included studies were of low to moderate methodological quality with discrepancies in reporting. Study heterogeneity was not conducive to data pooling.”
Translation: the studies are inconsistent and we couldn’t combine the data meaningfully.
Of those five:
- Two scored so low on methodological quality (23% and 35%) that they’re hard to draw conclusions from
- The remaining three are higher quality but share some concerning features
Let’s look at the better studies.
The Pastore Studies: Good Research, But Probably Not Independent
Two of the studies come from Antonio Pastore’s research group at Sapienza University of Rome:
Pastore et al. 2012: Compared pelvic floor rehabilitation to dapoxetine (an SSRI) in 40 patients. 19 got pelvic floor rehab, 21 got the drug.
Pastore et al. 2014: Single-arm study of pelvic floor rehabilitation in 40 patients.
Both show promising results. In 2012, 57% of the rehab group gained ejaculatory control. In 2014, 82.5% did.
Here’s the issue: these are almost certainly not independent samples.
The evidence:
- Same institution, same lead author, same protocol
- Enrollment periods overlap (2012 study: July 2010-August 2011; 2014 study: July 2010-August 2012)
- Most tellingly: both papers report responder IELT ranges of 123.6–152.4 seconds — identical to the decimal point
The most plausible explanation is that the 19 rehabilitation patients from 2012 were incorporated into the 40-patient cohort in 2014.
This matters because systematic reviews and meta-analyses often cite both studies as separate evidence. If they share patients, that’s double-counting, artificially inflating our confidence in the intervention.
To be clear: this isn’t fraud. It’s common in research to publish preliminary results and then expanded cohorts. But it means we have less independent evidence than it appears. So really our systematic review has only 2 studies.
Now let’s take the latter study for our review:
Sample size: 40 (38 completed, 2 dropped out)
Results:
- 33 of 40 (82.5%) “gained control of their ejaculation reflex”
- Mean IELT: 31.7 seconds → 146.2 seconds at 12 weeks
Issues:
- Very small sample size
- No control group
- Kegels not tested alone, they were done in combination with electrostimulation of the anus (more on this later)
The Other Study - Kurkar et al. (2015)
The other study referenced is interesting because it actually compares pelvic floor training to medication (sertraline) and to combination therapy.
Sample size: 74
Design: Same patients tried all three approaches sequentially (no control group, but at least within-subject comparison)
Results:
- Sertraline alone: IELT reached 121.69 seconds (59% failed to exceed 120 seconds)
- Pelvic floor alone: IELT reached 174.73 seconds (17.5% failed to exceed 120 seconds)
- Combination: IELT reached 297.57 seconds
What this actually shows:
Pelvic floor training outperformed sertraline alone. Combined approach was best. This is actually useful data, it suggests pelvic floor work adds something real.
But note:
- These were patients who had already tried SSRIs and were unsatisfied so a specific subset of PE havers
- Still includes electrostimulation in the pelvic floor protocol
- Still no control group
- The fact that combination therapy worked best supports my thesis: pelvic floor training probably helps some people as part of a comprehensive approach, not as a standalone magic bullet
The Elephant in the Room: Nobody Tested Kegels Alone
Here’s what surprised me most: almost no study has tested kegel exercises by themselves for PE.
Every single study in the literature uses multi-component protocols. The Pastore protocol, for example, included:
- Physio-kinesiotherapy (the kegel-type exercises)
- Electrostimulation via anal probe — electrical pulses directly stimulating the pelvic floor muscles
- Biofeedback — real-time monitoring of muscle contractions
Each component got 20 minutes during 60-minute sessions, three times weekly, for 12 weeks.
The Myers & Smith systematic review confirms this: “All studies used electrical stimulation as part of the pelvic floor muscle training.”
This is a significant problem for the “just do kegels at home” advice. The evidence supports clinic-based multi-component pelvic floor rehabilitation, not simple home exercises.
Can we isolate which component is actually helping? Not from this research. It could be:
- The kegels building muscle strength
- The electrostimulation directly modulating the pudendal nerve
- The biofeedback teaching body awareness
- Some synergistic combination
- Or even just the consistent attention to the pelvic region for 12 weeks
We genuinely don’t know.
Electrostimulation Isn’t Just “Assisted Kegels”
You might think electrostimulation is just helping people do kegels better. But research suggests it works through genuinely different mechanisms.
Neuromuscular disruption: Cizmeci et al. (2024) found in animal models that low-frequency electrical stimulation creates a sustained contraction state that prevents the rapid rhythmic contractions required for ejaculation. This is mechanistically distinct from voluntary contractions.
Nerve modulation: Electrical stimulation activates pudendal nerve pathways that may not be accessible through voluntary effort. Dorsal penile nerve stimulation has shown sustained IELT improvements in case reports.
Tissue changes: A 2022 systematic review found that pelvic floor electrostimulation promotes muscle fiber changes, collagen production, and nerve regeneration through molecular pathways that may exceed what voluntary training achieves.
Studies using electrostimulation-based approaches have shown 3-7x IELT improvements. A 2023 RCT of a wearable device (vPatch) showed 3.1-fold improvement versus sham.
I’m not saying electrostimulation is the secret and kegels do nothing. I’m saying we can’t separate them with current evidence, and they may work through different mechanisms entirely.
The One Study That Tested Kegels Against Something Else
There’s one study that came close to isolating kegels: Jiang et al. (2020) compared kegel exercises to “penis-root masturbation” (a specific technique) for primary PE.
The result? The kegel group performed significantly worse (p<0.05).
Now, this is just one small study (19 participants in the kegel arm), and it’s comparing kegels to an active intervention rather than a placebo. We shouldn’t draw strong conclusions.
But it’s notable that the only study even attempting to isolate kegels didn’t show them winning.
What About Response Rates?
Even in the positive studies, response rates vary considerably:
- La Pera & Nicastro (1996): 61% improved (11/18 patients)
- Pastore 2012: 57% improved (11/19)
- Pastore 2014: 82.5% improved (33/40)
- Other studies: 55-83%
This means 17-45% of patients don’t respond at all, even with the full multi-component protocol including electrostimulation and biofeedback.
If nearly half of patients in some studies don’t respond to intensive clinic-based rehabilitation, how many would respond to home kegels alone? We don’t know, but likely fewer.
What the Research Actually Supports
Let me be precise about what the evidence shows:
Supported by evidence:
- Multi-component pelvic floor rehabilitation (kegels + electrostimulation + biofeedback) helps some men with PE
- Response rates in these programs range from 55-83%
- The effects appear to persist at follow-up (3-6 months post-treatment)
Not supported by evidence:
- That kegel exercises alone help PE
- That home-based kegel programs are effective
- That pelvic floor training should be the default first-line treatment for all PE
Unknown:
- Which component(s) of multi-component protocols are doing the work
- Whether electrostimulation is necessary or just helpful
- What predicts who will respond vs. not respond
Why This Matters for You
If you’re dealing with PE, what should you take from this?
First, be skeptical of “just do kegels” advice. The evidence doesn’t support simple home kegel exercises as a standalone treatment. The studies used intensive protocols with equipment most people don’t have access to.
Second, pelvic floor work probably helps some people as part of a comprehensive approach. The response rates aren’t zero — 55-83% improved in the studies. Pelvic floor dysfunction is a real thing, and addressing it can matter.
Third, if nearly half of patients don’t respond even to intensive protocols, there are clearly other factors at play. As I wrote in our post on the real causes of PE, premature ejaculation has multiple potential causes — nervous system hyperreactivity, poor arousal awareness, conditioned patterns, and yes, pelvic floor issues.
Kegels target one potential cause. If that’s not your main issue, they won’t help much.
This is why we built Control: Last Longer with an assessment that tries to identify which factors are contributing to your PE before prescribing exercises. Cookie-cutter advice based on weak evidence applied uniformly to everyone is how we got into this mess.
The Bottom Line
The evidence for pelvic floor training helping PE is real but limited:
- Small studies, mostly from one research group
- Multi-component interventions that can’t be separated
- No evidence for kegels alone
- Significant non-response rates
Kegels aren’t useless. But they’re not the evidence-based slam dunk they’re presented as. They should be part of a personalized approach, not the default answer for everyone.
Next time someone confidently tells you “studies show kegels help PE,” you can ask: which studies? How many participants? Did they use electrostimulation? What was the non-response rate?
The honest answer is more nuanced than the headlines.
Download Control on the App Store — personalized PE training based on your actual causes, not one-size-fits-all advice.
Got a correction or counter-evidence? Email me at adam@controltheapp.com — I’ll update the post if I got something wrong.
References
- Myers C, Smith M. Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: a systematic review. Physiotherapy. 2019.
- Pastore AL, et al. A prospective randomized study to compare pelvic floor rehabilitation and dapoxetine for treatment of lifelong premature ejaculation. Int J Androl. 2012;35(4):528-533.
- Pastore AL, et al. Pelvic floor muscle rehabilitation for patients with lifelong premature ejaculation: a novel therapeutic approach. Ther Adv Urol. 2014;6(3):83-88.
- La Pera G, Nicastro A. A new treatment for premature ejaculation: the rehabilitation of the pelvic floor. J Sex Marital Ther. 1996;22(1):22-26.
- Cizmeci et al. Effects of electrical stimulation on ejaculation latency. 2024.
- Jiang et al. The efficacy of regular penis-root masturbation versus Kegel exercise in the treatment of primary premature ejaculation. 2020.
- Kurkar A, et al. Treatment of premature ejaculation: a new combined approach. Egypt Rheumatol Rehabil. 2015;42(1):39-44.