(284) EFFICACY OF PELVIC FLOOR MUSCLE TRAINING AND KEGEL EXERCISES IN THE TREATMENT OF PREMATURE EJACULATION: AN INTEGRATIVE LITERATURE REVIEW
Authors: Tunes De Paula A , Gonçalves Da Silva M , Cristina Da Cruz M , Felipe Sousa De Almeida L , Barbosa Reis A 
Published: December 2024

Abstract

Introduction
Premature ejaculation (PE) is one of the most prevalent male sexual disorders and significantly affects the quality of life of both patients and partners. Although pharmacological treatments are commonly used, non-pharmacological physiotherapeutic interventions such as pelvic floor muscle training (PFMT) and Kegel exercises (KE) have gained attention for their therapeutic potential in managing PE.

Objective
The present review aims to evaluate current literature on the efficacy of physiotherapy, including PFMT and KE in the treatment of premature ejaculation.

Methods
A search was conducted in Google Scholar, PubMed, and Cochrane Central databases using the keywords “premature ejaculation,” “pelvic floor muscle training,” “physiotherapy,” and “Kegel.” Studies were included if they assessed these interventions for PE and reported outcomes related to intravaginal ejaculatory latency time (IELT) and self-reported PE severity, regardless of the therapeutic association with other interventions. Duplicate studies and those focusing on erectile dysfunction exclusively were excluded. Specific guidelines from the International Society for Sexual Medicine (ISSM), the American Urological Association (AUA), and the European Association of Urology (EAU) were also included in the comparative analysis.

Results
From the search, 154 studies were identified, with 15 meeting the inclusion criteria. The evaluated studies consistently demonstrated that pelvic floor muscle training significantly improved IELT and reduced the severity of PE. A study by Pastore et al. (2014) reported that 82.5% of patients who completed a 12-week PFMT program improved their IELT from a baseline of less than 60 seconds to an average of 146.2 seconds. Similarly, La Pera (1996), one of the earliest studies included, found that 61% of patients achieved satisfactory control of their ejaculatory reflex after completing a series of PFMT sessions. Studies that combined PFMT with biofeedback and electrostimulation also reported substantial improvements. Long-term studies indicated sustained benefits for as long as 60 months. The ISSM, AUA, and EAU guidelines recommend a multimodal approach to managing PE, including pharmacological treatments, behavioral therapy, and psychological support. However, these guidelines do not extensively include physiotherapy interventions.

Conclusions
The current literature supports the efficacy of pelvic floor muscle training and physiotherapy as effective non-pharmacological treatments for premature ejaculation. These interventions provide significant improvements in IELT and PE severity, with sustained benefits over time and lack the most common side effects that pharmacological interventions include. Pelvic floor rehabilitation represents a promising therapeutic option for PE, offering a viable alternative or adjunct to pharmacological treatments. However, the quality of the studies reviewed varies significantly, with some studies having small sample sizes and a significant exposition to biases. Furthermore, the overall number of high-quality studies is limited, indicating the need for future research with larger-sampled, well-designed randomized and controlled trials to confirm these findings and establish standardized treatment protocols.

Disclosure
No.