The Horse Trick for Erectile Dysfunction: Does Pelvic Floor Training Actually Work?
The 'horse trick' is a TikTok name for pelvic floor training that targets the muscles behind erections. Here's what the trials show and how to do it correctly.
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Key Takeaways
The horse trick is a pelvic floor exercise technique that strengthens the muscles behind erections. Clinical trials show about 40% of men who do it consistently recover normal erectile function within 3 months. It works best for venous leak or post-prostatectomy ED, not for all causes.
What the horse trick actually is#
The 'horse trick' is a social media term for pelvic floor muscle training (PFMT), specifically a two-phase technique that first relaxes, then contracts, the muscles at the base of the penis. The name comes from the visible flicking movement, similar to the way a horse twitches its skin. It went viral on TikTok and Reddit because it promised a drug-free fix for erectile dysfunction (ED). The underlying exercise is not new or fringe: it targets the bulbocavernosus and ischiocavernosus muscles, which are the same muscles responsible for maintaining penile rigidity during an erection.
There is no clinical term called the 'horse trick'. In published research, this exercise category is called pelvic floor muscle training or PFMT.
How these muscles affect your erections#
An erection depends on blood filling the two chambers of the penis (the corpora cavernosa) and staying there. The bulbocavernosus and ischiocavernosus muscles compress the veins at the base, reducing outflow and maintaining pressure. If these muscles are weak, blood drains too quickly and the erection loses rigidity before or during sex. This is sometimes called venous leak, and it is one of the causes of ED most likely to respond to pelvic floor training.
Vascular disease, high blood pressure, diabetes, and hormonal problems cause ED by different mechanisms. PFMT is unlikely to fully resolve ED rooted in arterial disease or low testosterone, though it may still improve things at the margin.
Finding the right muscles first#
Most men who start pelvic floor exercises immediately get the wrong muscles. Squeezing your buttocks or bearing down (like straining to empty your bowels) does nothing useful here.
To find the correct muscles, try to stop the flow of urine mid-stream. The muscles you engage to do that are the ones you need. Alternatively, try to lift the base of your penis upward without using your hands. You should feel a subtle tightening at the perineum (the area between the scrotum and anus), not in the abdomen, thighs, or buttocks.
If you cannot isolate these muscles, a pelvic floor physiotherapist can help. NHS referral for pelvic floor physiotherapy is available through your GP, though waiting times vary. Private sessions are also an option.
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The two-phase technique, step by step#
The horse trick differs from a standard Kegel because it adds a deliberate relaxation phase before the contraction. A standard Kegel just squeezes and releases. The horse trick sequence is:
- Breathe in and deliberately let the pelvic floor drop and relax (the 'reverse Kegel' or push-out phase). Hold this relaxed state for 3 seconds.
- Without holding your breath, squeeze the pelvic floor muscles upward and inward. Hold the contraction for 5 seconds.
- Slowly release back to neutral. Rest for 5 seconds.
- Repeat for 10 repetitions.
Aim for 3 sets, three times a day. After 4 weeks, increase the hold during contraction to 8 seconds. After 8 weeks, aim for 10-second holds. Consistency matters more than intensity.
Common mistakes: tensing the abdomen, holding the breath, squeezing the buttocks, or rushing through the relaxation phase. The relaxation phase is not just a gap between reps; it trains the muscle to work through its full range.
What the clinical trials show#
The key trial cited in most reviews is the Dorey et al. randomised controlled trial published in 2004. After 3 months of PFMT, 40% of men in the training group recovered normal erectile function, compared with 17.6% in the control group. A further 35.5% of the PFMT group showed improvement, versus 14.7% of controls.
A 2020 systematic review in the journal Sexual Medicine Reviews confirmed that PFMT consistently improved erectile function scores across multiple trials, with the strongest effect in men with venous leak-related ED and in men recovering from radical prostatectomy (prostate removal surgery).
The evidence is moderate quality overall. Most trials are small, but the direction of benefit is consistent.
Which type of ED is most likely to respond#
| ED cause | Expected benefit from PFMT |
|---|---|
| Venous leak (blood drains too fast) | Good evidence of benefit |
| Post-prostatectomy ED | Good evidence, especially started early |
| Lifestyle-related (obesity, alcohol, smoking) | Moderate benefit, best combined with lifestyle changes |
| Psychological / performance anxiety | Limited direct benefit; psychosexual support more useful |
| Arterial / cardiovascular disease | Limited; treat the underlying cause first |
| Low testosterone | Unlikely to help; hormonal assessment needed |
New-onset ED can sometimes be an early sign of underlying cardiovascular disease. NICE and NHS guidance recommends that men with new or unexplained ED seek a GP assessment before self-treating, so that any underlying conditions are identified and managed appropriately. If you are unsure what is causing your ED, a proper assessment is worthwhile before assuming exercises alone will solve it.
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Combining pelvic floor training with lifestyle changes#
NICE guidance on ED supports lifestyle modification alongside any treatment. Reducing alcohol, stopping smoking, losing weight if needed, and exercising regularly all improve erectile function independently of pelvic floor training. These changes also address the cardiovascular risk that often accompanies ED. Combining PFMT with lifestyle modifications gives you a better chance of meaningful improvement than either alone.
Is it an alternative to sildenafil?#
Not a straightforward swap. Pelvic floor training takes weeks to show results and works best for specific causes of ED. Sildenafil (the active ingredient in Viagra) works within 30 to 60 minutes for most men on an empty or light stomach; taking it after a high-fat meal can delay absorption significantly and is worth bearing in mind when planning timing.
For men who prefer to avoid medication, PFMT is a legitimate first step, particularly for mild to moderate ED with no clear vascular or hormonal cause. For men with more significant ED, combining exercises with a PDE5 inhibitor (sildenafil or tadalafil) is often the most practical approach.
Viagra Connect (sildenafil 50 mg) has been available over the counter in UK pharmacies since 2018. Generic sildenafil also received pharmacy (P) status in the UK in 2023, meaning it too can now be purchased without a prescription at a pharmacy. Prescription-strength sildenafil is also available through online pharmacies like Totiva, where a free consultation determines whether treatment is suitable for you. See Totiva's ED service for a full overview of available options.
If you want to understand how medication timing works alongside exercises, the guide on how long Viagra lasts covers the pharmacology in plain terms.
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Medical Information: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, stopping, or changing any treatment.
