A sling of muscle at the base of your pelvis running from pubic bone to tailbone. In men, the key players are the bulbospongiosus (surrounds the base of the penis, contracts during ejaculation and helps trap blood during erection), the ischiocavernosus (helps maintain erectile rigidity), the pubococcygeus and iliococcygeus (support the pelvic organs and contribute to continence), and the external urethral and anal sphincters.
"Kegels" — named for gynecologist Arnold Kegel who developed them in the 1940s — are voluntary contractions of these muscles. They work in men. The bigger question is: for what, and how.
Not every claim you see attached to Kegels is backed by research of equal quality. Here's what the strongest evidence supports, and how big the effect actually is.
The landmark study is Dorey and colleagues' randomized controlled trial published in BJU International in 2005. They enrolled 55 men with erectile dysfunction (median age 59) and randomized them to structured pelvic floor exercises with biofeedback plus lifestyle advice, or lifestyle advice alone. Control patients who didn't respond by 3 months crossed over into the intervention.
Blinded assessment by a urologist. Erectile function measured by IIEF. Dorey et al., BJU International 2005;96:595–597.
That's a real effect, not placebo-scale noise. But note the ceiling: three-quarters of men benefited to some degree, and one-quarter didn't. This is a first-line, low-risk intervention with a reasonable success rate — not a guaranteed fix. The mechanism is thought to involve stronger ischiocavernosus and bulbospongiosus contraction improving venous occlusion (keeping blood in the erection), plus improved awareness and voluntary control during arousal.
This is where the evidence is strongest. Filocamo and colleagues, in a randomized controlled trial published in European Urology in 2005, took 300 men who had just undergone radical retropubic prostatectomy and randomized them 1:1 to structured pelvic floor training initiated immediately after catheter removal, or to no formal instruction.
Assessed by pad tests and ICS-Male questionnaire. Filocamo et al., European Urology 2005;48:734–738.
Both the European Association of Urology and the American Urological Association now list pelvic floor muscle training as a first-line conservative treatment for post-prostatectomy stress urinary incontinence. If you or someone you know is facing radical prostatectomy, starting pelvic floor training before surgery — not just after — has stronger evidence than doing nothing until you leak.
The classic "shake and shake, and it dribbles anyway" phenomenon — a small amount of urine escaping after voiding is complete — is often driven by residual urine sitting in the bulbar urethra. A properly-timed "squeeze out" pelvic floor contraction after voiding empties the bulb. This has its own supporting RCT (Dorey et al., 2004) and is a simple, high-yield application: contract the pelvic floor firmly a few seconds after you finish, and you'll often get a bit more out and skip the dribble.
Cochrane and ICS guidelines list PFMT as a first-line option for overactive bladder in men, with recent RCT support (including PFMT combined with the urgency-suppression technique showing significantly better urgency and voiding outcomes than medication alone). For premature ejaculation, pelvic floor training also has RCT support — covered in more depth in our PE article — with a well-known 2014 trial showing large improvements in intravaginal ejaculatory latency in the majority of men who completed the program.
Here's what almost no mainstream Kegels content gets right: a pelvic floor that's already too tense doesn't need more strengthening. It needs the opposite — down-training, or learning to release. And a meaningful subset of men who show up asking about Kegels actually have this problem, not the one they think.
The clinical name for chronically over-contracted pelvic floor is hypertonic (or overactive) pelvic floor. Symptoms overlap heavily with what people assume is a weak pelvic floor, which is exactly why it gets missed:
This constellation overlaps almost entirely with what's called chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) — a condition that affects an estimated 2–16% of men at some point. Despite the name, most men with CP/CPPS don't have infected prostates; they have muscular and neural dysfunction of the pelvic floor.
A 2022 case-control study (n=90; 42 men with CP/CPPS, 48 controls) used electromyography to measure pelvic floor muscle activity at rest. Men with CP/CPPS had a measurably impaired ability to relax their pelvic floor muscles between voluntary contractions (P<.0001) — even when instructed to rest. In other words: their pelvic floors were holding tension they couldn't switch off on demand.
Case-control study on impaired PFM relaxation in CP/CPPS, published in Journal of Urology 2022 (PMID 35576002).Prescribing strengthening exercises for a muscle group that's already over-contracted is a textbook mistake — and it's the reason a lot of men with pelvic pain report that Kegels made them feel worse. Pelvic floor specialists (physiotherapists with specific training in men's pelvic health) will typically start with relaxation, breathing, myofascial release, and trigger-point work in these cases — not contraction training. Strengthening only enters the picture, if at all, once relaxation is competent.
If you have any of the CP/CPPS-pattern symptoms above, don't start Kegels blind. See a pelvic health physiotherapist or a urologist familiar with pelvic pain first.
The single most common mistake in male Kegels is contracting the wrong muscles — usually the glutes, abs, or thighs — and thinking it counts. It doesn't. The signal you're looking for is specifically the muscles around the base of the penis and the anus.
1. The visual test. Stand naked in front of a mirror. Without moving anything else, try to make your penis "twitch upward" while flaccid. That subtle lift is the bulbospongiosus firing. If nothing moves, you may not be contracting them yet.
2. The gas-holding cue. Imagine you're about to pass gas in a quiet room and you need to stop it. That "close and lift" sensation around the anus is the puborectalis and external anal sphincter — same functional group.
3. The mid-stream test (once only). The next time you urinate, try to stop the stream mid-flow. The muscles you use are your pelvic floor. This is a location exercise, not a training exercise — repeatedly interrupting urination can create bladder dysfunction over time. Use it once to identify the muscles, then never again.
Clenching the glutes hard, gripping the inner thighs, holding the breath, and pulling in the belly — while assuming that's the "hard" version of a Kegel.
Glutes, thighs, abs, and breath all stay relaxed. Only the muscles around the base of the penis and anus lift and squeeze. If you can't isolate them yet, that's the first thing to work on — quality before quantity.
The RCT protocols that produced the results above weren't random or vague. They combined slow endurance contractions with fast twitch contractions, prescribed in specific ratios, and — importantly — treated the relaxation phase as being as important as the contraction phase. Here's the general structure:
| Rep type | Prescription | Purpose |
|---|---|---|
| Slow hold | Contract, hold 5–10 s, fully release 10 s | Endurance (slow-twitch fibres) — bladder support, erection maintenance |
| Fast twitch | Rapid contract-release, 1 s on / 1 s off | Reflexive continence (cough, sneeze, lifting) and ejaculatory control |
| Sets | ~10 slow + ~10 fast, 3 sessions per day | Enough total volume without over-training |
| Timeframe to results | 4–6 weeks minimum, 12+ weeks for full effect | Neuromuscular adaptation takes as long as any other muscle |
Adapted from the Dorey RCT protocol and standard pelvic health physiotherapy practice. Individualized programs from a trained physio will beat generic prescriptions for people with specific issues.
A contraction without a full release isn't half a rep — it's a rep that trains your pelvic floor to stay contracted. That's the direct road to hypertonicity. If you can't fully let go between reps, drop the hold time until you can. The Dorey trial explicitly built full relaxation into every rep, and every good pelvic health physio will tell you the same.
The single highest-yield step for most men with any of the issues below is an in-person assessment with a pelvic health physiotherapist (in some regions called a men's health physio, pelvic physio, or pelvic rehab specialist). They can palpate the muscles directly, use ultrasound or surface EMG to check what you're actually recruiting, and distinguish between a weak floor that needs Kegels and an overactive one that needs the opposite.
Situations where a specialist assessment beats guessing on your own: