The Truth About Kegels: Squeeze, Yes — But Learn to Let Go

Meet your pelvic floor

Your pelvic floor is a hammock of muscles and connective tissue slung between your pubic bone at the front, your tailbone at the back and your sit bones on either side. Everyone has one, whatever their anatomy. It holds up your bladder, bowel and (if you have one) uterus; it helps keep you continent by closing around the urethra and anus; and it takes part in sexual response, including the rhythmic contractions of orgasm.

Like any muscle group, it can be too weak, too tense, badly coordinated, or some mix of all three. That is the part most “just do your Kegels” advice skips.

What the evidence says about leaks

“Kegels” is the everyday name for pelvic floor muscle training (PFMT), named after the gynaecologist Arnold Kegel, who popularised the exercises in the 1940s and 50s. For bladder leaks, this is one of the better-supported interventions in conservative medicine.

A 2018 Cochrane systematic review pooled 31 trials with 1,817 women. Among women with stress urinary incontinence — leaking when you cough, sneeze, laugh, jump or lift — those who did PFMT were about eight times more likely to report cure than those who had no treatment or a sham (56% versus 6%), and roughly six times more likely to report cure or improvement. For women with any type of incontinence, the training group was about five times more likely to report cure. Adverse events were rare and minor. The authors concluded that PFMT belongs in first-line conservative care.

That is why UK clinical guidance from NICE recommends a trial of supervised pelvic floor muscle training lasting at least three months as a first-line treatment for stress or mixed incontinence. Note the word supervised: studies consistently do better when someone checks that you are actually using the right muscles.

What about sex?

This is where the internet gets ahead of the science. The same Cochrane review noted that women in the training groups reported better sexual outcomes — encouraging, but sexual function was a secondary outcome in a small number of trials, not the main question.

For people with a penis, a small but well-known randomised trial from 2004 (55 men with erectile difficulties) found that pelvic floor exercises plus biofeedback improved erectile function scores compared with lifestyle advice alone; by the end of the study, 40% had regained normal function and another 35% had improved. That is promising, but it is one modest trial, not a guarantee — and erection problems can be an early sign of cardiovascular issues, so they are worth a check-up first.

The honest summary: a well-trained, responsive pelvic floor can support sexual function, and stronger evidence exists for leaks than for pleasure. Be wary of anyone promising “tighter” or “better” sex from Kegels alone.

The part most Kegel advice leaves out: letting go

Not every pelvic floor problem is a weak one. Some people have a pelvic floor that is overactive — clinicians call it non-relaxing pelvic floor dysfunction or a hypertonic pelvic floor. The muscles stay partly switched on all the time and struggle to release.

A review in Mayo Clinic Proceedings describes how this can show up as a scattered set of symptoms: pelvic or genital pain, pain with penetration, a feeling of incomplete emptying, straining or constipation, urinary urgency or frequency. Because these symptoms look unrelated, the condition is often missed.

If your muscles are already gripping, adding hundreds of squeezes is like doing bicep curls for a cramped arm. The first job is to release: breathing, relaxation, and often hands-on guidance from a pelvic floor physiotherapist. Strength work comes later, if at all.

A strong pelvic floor isn’t one that squeezes hardest. It’s one that can squeeze when you need it and let go completely when you don’t.

How to do a Kegel properly: squeeze and relax

1. Find the muscles. Sitting or lying comfortably, imagine stopping yourself passing wind and, at the same time, stopping the flow of urine. You should feel a gentle lift and squeeze inward and upward. Don’t practise by actually stopping your urine stream — that is only for a one-off check, if at all.
2. Breathe. Breathe out as you squeeze. Don’t hold your breath, clench your buttocks, squeeze your thighs or pull your stomach in hard.
3. Relax fully. After every squeeze, let the muscles drop all the way back down. Aim to relax for at least as long as you squeezed — many physios suggest twice as long.
4. Slow holds. Build toward holding for up to 10 seconds, then relaxing for 10.
5. Quick flicks. Add short, fast squeezes (about one second on, one second fully off) — these train the reflex that helps when you cough or sneeze.
6. Be consistent. NICE’s guidance suggests at least eight contractions, three times a day, kept up for at least three months. Results take weeks, not days.

Common mistakes

• Squeezing the wrong muscles: glutes, inner thighs or abs doing the work instead.
• Bearing down (pushing outward) instead of lifting in. If you’re unsure which you’re doing, that alone is a good reason to see a physio.
• Never relaxing: a series of squeezes with no real rest in between.
• Overdoing it: more is not better, especially if you notice pain or soreness afterwards.
• Giving up at week two: muscle adaptation takes time; most trials run for around three months.

The bottom line

Kegels are genuinely useful — for leaks, the evidence is strong. For sex, they may help, especially as part of a broader approach. But the goal isn’t the tightest possible pelvic floor; it’s a responsive one. Squeeze, then let go. And if anything hurts, stop and get assessed.