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Kegel Exercises: What They Do and How to Do Them Right
How To
7 min read
Most people have heard of them. Far fewer are doing them correctly.
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Kegel exercises are recommended by physiotherapists, urologists, obstetricians, and sexual health clinicians - and misunderstood by a large proportion of the people who attempt them. The name comes from Arnold Kegel, the American gynaecologist who published the foundational research in the late 1940s and early 1950s, and the exercise itself is simple in description: contract the pelvic floor muscles, hold, release. The difficulty is that most people do not accurately identify which muscles they are contracting, and many perform the movements in ways that produce no benefit. Understanding the anatomy first changes how effectively the exercise is done.
The pelvic floor is a group of muscles, ligaments, and connective tissue that forms the base of the pelvic cavity - roughly like a hammock suspended between the pubic bone at the front and the coccyx (tailbone) at the back. The primary muscles involved are collectively called the levator ani group, which is itself composed of three distinct muscles: the pubococcygeus, the iliococcygeus, and the puborectalis. A fourth muscle, the coccygeus, sits alongside them.
These muscles perform several distinct functions simultaneously. They support the pelvic organs - the bladder, uterus or prostate, and rectum - against the downward pressure of gravity and intra-abdominal pressure. They control the openings of the urethra, vagina, and anus, enabling voluntary control of urination, defecation, and penetrative sex. They participate in the muscular contractions of orgasm in all sexes. And they work together with the diaphragm and deep abdominal muscles as part of the core pressure management system of the torso.
Because the levator ani must do all of these things simultaneously, it is under near-constant low-level demand. Like any postural muscle, it can become weakened through disuse, injury (including childbirth), or hormonal changes. It can also become overactive - chronically tense rather than appropriately toned - which creates a different set of problems. Kegel exercises address the weakness side of this spectrum; people with pelvic floor hypertonicity need a different approach.
The physiological effects of pelvic floor training fall into several categories. The most extensively researched is urinary continence: the levator ani supports the urethra and helps maintain urethral closure pressure against sudden intra-abdominal pressure increases (coughing, sneezing, jumping). Weakness in these muscles is a primary cause of stress urinary incontinence, and strengthening them through Kegel training is the first-line conservative treatment recommended by continence guidelines.
Beyond continence, there are two mechanisms through which pelvic floor training is thought to influence sexual function. The first is increased blood flow to the pelvic region. Muscular contraction and the recovery between contractions drive local circulation, and the increased vascularisation of the pelvic floor and surrounding genital tissue is associated with better arousal response, lubrication in people with vaginas, and erectile quality in people with penises.
The second mechanism is more direct: the pelvic floor muscles are the muscles that contract rhythmically during orgasm. Stronger, better-coordinated levator ani muscles have been associated with more intense orgasmic contractions and better voluntary control over the timing of those contractions. Bo reviewed the relationship between pelvic floor function and sexual experience in a 2004 paper, noting the anatomical basis for this connection and the evidence from training studies.
Beji and colleagues published a study in 2003 (PubMed 12560782) examining the effects of pelvic floor muscle training on sexual function in women who had previously undergone gynaecological surgery. After a structured programme of pelvic floor exercises, participants reported improvements across multiple sexual function domains, including desire, arousal, lubrication, orgasm, satisfaction, and a reduction in pain during sex. The results were consistent with the anatomical logic: better-perfused, better-toned pelvic tissue responds differently to stimulation.
The evidence extends to male sexual function. Dorey and colleagues published a randomised controlled trial in 2005 (PubMed 15736573) examining pelvic floor muscle training as a treatment for erectile dysfunction and premature ejaculation. Men randomised to the exercise group performed daily pelvic floor contractions for six months. The results were striking: 40% of men in the exercise group regained full erectile function, and a further 35% showed significant improvement. The control group, which received lifestyle advice only, showed considerably smaller gains. The pelvic floor muscles in men include the bulbocavernosus and ischiocavernosus muscles, which help maintain penile rigidity by compressing the dorsal penile vein and maintaining internal pressure in the corpora cavernosa.
These findings do not mean pelvic floor exercises are a substitute for addressing the underlying causes of sexual dysfunction. But they do mean the exercises have a genuine, measurable effect on sexual function outcomes beyond their well-established urinary continence benefits.
The first step is identifying the right muscles. The most reliable method: imagine you are stopping the flow of urine midstream, or preventing yourself from passing gas. The internal lift and squeeze you feel in the perineal region - not a squeeze of the thighs, not a tightening of the abdomen, not a clenching of the glutes - is the levator ani contracting. Do this in an empty bladder state; actually stopping urine flow during urination is not recommended as a regular practice as it can interfere with normal bladder emptying reflexes.
Once you have identified the muscles, the basic technique is straightforward. Contract the pelvic floor muscles and hold the contraction for a count of three to five seconds. Then fully release and rest for a count equal to or longer than the hold - relaxation is as important as contraction. Repeat this cycle 10 to 15 times per set. Work toward building up to a 10-second hold with a 10-second rest, three sets per day.
The release phase deserves emphasis. Many people hold some residual tension in the pelvic floor between contractions, which means the muscle never fully rests and recovery is incomplete. A proper release should feel like a lowering or dropping sensation in the perineum. If you are unsure whether you are fully releasing, the relaxation is probably incomplete.
There is also a rapid-contraction variation: quick, brief contractions and releases, sometimes called "quick flicks," that train the fast-twitch muscle fibres. These complement the slower endurance contractions and are particularly relevant for the reflex continence response to sudden pressure (coughing, sneezing). A complete programme includes both types.
The most prevalent mistake is recruiting the wrong muscles. Many people, when asked to do Kegels, will tighten their glutes, hold their breath, or brace their abdominals - and feel no levator ani activity at all. Because the pelvic floor is internal and the contractions produce no visible movement, it is easy to perform the exercise incorrectly and have no way of knowing.
A related mistake is holding the breath during contractions. The pelvic floor coordinates with the diaphragm as part of the intra-abdominal pressure system - breath-holding creates a Valsalva manoeuvre that increases intra-abdominal pressure and actually works against pelvic floor function. Breathe normally throughout the exercise.
Another common error is skipping the rest phase. The contraction phase is where the work happens, but the rest phase is where adaptation occurs. Performing Kegels continuously without adequate rest between repetitions fatigues the muscle without allowing the recovery that drives improvement. A rest at least as long as the hold is the standard recommendation.
Finally, many people do Kegels irregularly - several sets one day, nothing for a week. Like any muscle training, pelvic floor exercise requires consistency. The research protocols that produced measurable improvements ran for 8 to 12 weeks of daily or near-daily practice. Short bursts of activity separated by long gaps produce minimal adaptation.
If you are unsure whether your technique is correct, a pelvic floor physiotherapist can provide real-time feedback using biofeedback tools that confirm whether the levator ani is contracting and releasing appropriately. For people with significant continence or sexual function concerns, this professional guidance is worth pursuing rather than relying on self-directed practice alone.