Educational content. This article does not replace consultation with a doctor or pelvic physiotherapist. For persistent symptoms or pre-existing conditions, seek professional guidance before starting any exercise routine.
Many men who take tadalafil reach a similar point: the medication works, but the erection still depends on it. Without the pill, firmness starts to waver again. And there is a quiet question underneath, one that almost nobody brings to the doctor: is there anything to do besides taking it?
There is. This article explains why tadalafil and Kegel exercises act on different parts of the erection, what the studies show when the two are used together, and how Ritmo organizes the training for men who already use medication. One note before we start: the prescription, the dose and any change in how you take tadalafil are your doctor's call. Training comes in as a complement, never as a swap.
Tadalafil and Kegels together: the short answer
Short answer
Tadalafil and Kegel exercises are complementary because they act on different stages of the erection. Tadalafil makes it easier for blood to enter the penis by relaxing the arteries. The pelvic floor muscles, trained by Kegels, squeeze the veins at the base and keep that blood inside the corpora cavernosa. A trial by Dorey (2005) showed improved rigidity in 75.5% of men with training alone; combining the two covers inflow and retention at the same time.
What tadalafil does (and what it does not)
Tadalafil is an inhibitor of the enzyme PDE5. With sexual stimulation, the body releases nitric oxide, which relaxes the smooth muscle in the penile arteries and lets blood in. PDE5 is the enzyme that switches that signal off. By blocking it, tadalafil keeps the arteries open for longer. That is why it helps the erection start and fill.
What it does not do: hold the blood in. Retention depends on a mechanical mechanism, the compression of the drainage veins at the base of the penis. That job belongs to the ischiocavernosus and bulbocavernosus muscles, both part of the pelvic floor. When they are weak, blood comes in fine but leaves fast. Anyone on the medication knows the result: the erection arrives, then loses firmness halfway, or needs a higher dose to last.
Tadalafil also changes nothing permanently. One dose works for 24 to 36 hours and then wears off. It is a good drug precisely because it is predictable, but it trains nothing.
What Kegels do (and what they do not)
The male Kegel exercise is the voluntary contraction of the pelvic floor, the same muscles that stop the flow of urine. Trained regularly, they get stronger and better coordinated, and they compress the veins at the base of the penis more effectively during an erection. For a calm walk through the anatomy, read what the male pelvic floor is.
75.5% improved rigidity
In a clinical trial with 55 men with erectile dysfunction, 3 months of pelvic floor exercises improved rigidity in 75.5% of participants. 40% regained normal erectile function without any medication; another 35.5% improved partially. The group that responded least had severe vascular causes, exactly the profile where the drug matters most.
Dorey G, Speakman M, Feneley R, Swinkels A, Dunn C. Pelvic floor exercises for erectile dysfunction. BJU International. 2005; 96(4):595-597. DOI: 10.1111/j.1464-410X.2005.05690.x
What Kegels do not do: open the arteries. If inflow is compromised by a vascular cause, advanced diabetes or nerve damage, the strongest muscle in the world has nothing to hold. In those cases the medication remains the foundation of treatment, and training improves what the drug alone cannot reach.
Why the two work better together
Think of the erection in two stages. The first is filling: blood has to arrive. The second is holding: blood has to stay. Tadalafil handles the first. Kegels handle the second. A man on the drug alone can have an erection that fills well and empties early. A man who only trains can have ready muscles but little blood arriving. Together, they cover the whole cycle.
There is a second effect that gets less attention. The pressure inside the corpora cavernosa during a rigid erection is higher than arterial pressure. That is only possible because the ischiocavernosus squeezes the base of the penis and multiplies the pressure. Tadalafil brings the blood there; it is the muscle that turns volume into rigidity.
87% of men with ED gained intracavernous pressure
A study with 122 men with erectile dysfunction and 108 with premature ejaculation measured pressure inside the penis across 20 sessions of pelvic floor rehabilitation. Among those with a positive trend, 87% of men with ED and 88% of men with premature ejaculation increased the maximum pressure the ischiocavernosus muscle can generate. The gain showed up in the first sessions and kept growing with repetition.
Lavoisier P, Roy P, Dantony E, Watrelot A, Ruggeri J, Dumoulin S. Pelvic-floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Physical Therapy. 2014; 94(12):1731-1743. DOI: 10.2522/ptj.20130354
What happens when the combination is tested
Trials that put tadalafil and Kegels in the same protocol are still few. One of them, published in 2025, compared daily tadalafil 5 mg alone against tadalafil plus pelvic floor exercises in men with post-micturition dribble, the leftover urine that escapes after urinating. The symptom is urinary, but the muscles are the same ones that hold an erection, which is why the study matters here.
0.09 versus 1.37 on the dribble scale
Seventy men were split into two groups for 3 months: one took tadalafil 5 mg a day, the other took the same dose and did Kegel exercises. The combined group pulled ahead by week two (4.97 versus 6.2 on the symptom scale) and reached week ten at 0.09 versus 1.37. Fewer episodes, less volume and fewer non-responders in the group that trained.
AbdelKader MS, Mohamed MA, Abolyosr A. Efficacy of tadalafil 5mg versus its combination with pelvic floor muscles exercises in treatment of men with monosymptomatic post-micturition dribble: prospective, randomized, comparative study. SVU-International Journal of Medical Sciences. 2025; 8(2):933-942. DOI: 10.21608/svuijm.2024.303128.1920
It is worth being honest about the limit of that data: it measures dribble, not rigidity. What it shows is that adding training to the drug produced a result the drug alone did not, in the same muscles the erection uses. For rigidity itself, the evidence for training on its own (Dorey, Lavoisier) remains the strongest.
How to use both without getting in the way of treatment
- Do not change the dose on your own. If training improves firmness, tell your doctor. They decide whether to reduce it, switch to daily use or keep it as is. Stopping suddenly because "the Kegels handle it now" is the most common mistake.
- Train on different days from use, or earlier. Kegels do not interfere with tadalafil. What you do not want is to fatigue the muscle right before sex: a heavy session minutes before leaves the pelvic floor tired at the moment it needs to hold.
- Tell your doctor you are training. Better morning erections and less dependence on the dose are signals they will want in order to adjust the plan.
- Do not expect an immediate effect from training. Tadalafil acts in hours. Muscle responds to weeks of repetition. To know what to expect at each stage, see how long until you see results from pelvic exercises.
In Dorey's trials, pelvic floor training came in as a first-line treatment for erectile dysfunction, alongside medical guidance. Nobody was told to drop what they were already doing; the training added to it. Dorey G et al. Pelvic floor exercises for erectile dysfunction. BJU International. 2005.
How Ritmo puts this into practice
Ritmo is a guided pelvic floor training app for men. Each session lasts 5 to 10 minutes and is a sequence of 4 to 7 Kegel exercises, with a rest screen between them. During the exercise, the screen shows the timer and the current phase (contract, hold, release, rest), with synchronized vibration, so you can train with the phone in your pocket, anywhere you like.
The program alternates two session types with equal weight. Session A works strength and endurance, which is what holds blood in for longer. Session B works control and coordination, which is what lets you contract the right muscle at the right moment. Progression is automatic: each week adjusts contraction time and volume based on the one before, and the plan includes rest days, because muscle grows in the gap. For men on tadalafil, training changes nothing about the medication; it strengthens the part the drug cannot reach. If you are starting from zero, the complete male Kegel guide explains how to find the muscle before your first session.
Frequently asked questions
Can I do Kegels while taking tadalafil?
Yes. Kegel exercises do not interfere with how tadalafil works: the drug acts on the arteries (blood inflow) and the training acts on the pelvic floor muscles (blood retention). The two can run side by side. The only practical advice is not to do a heavy session minutes before sex, because a tired muscle holds less. Any change in dose remains your doctor's decision.
Do Kegels replace tadalafil?
That is not how it works. In Dorey's study (2005), 40% of men with erectile dysfunction regained normal function with training alone, but cases with severe vascular causes responded little and still needed medication. Training is a complement: it strengthens retention, which the drug does not work on. If firmness improves, bring it to your doctor; they decide whether to reduce, keep or change the regimen.
Why does the erection fill with tadalafil but not hold?
Because tadalafil only handles blood inflow. Keeping blood inside the penis depends on the ischiocavernosus and bulbocavernosus muscles, which compress the drainage veins at the base. When they are weak, blood comes in and leaves fast, and the erection loses firmness halfway. That is exactly the stage Kegel training strengthens, which is why medication and exercise complete each other.
Is there a study that tested tadalafil and Kegels together?
Yes, although few. A randomized trial from 2025 (AbdelKader et al.) split 70 men between daily tadalafil 5 mg alone and tadalafil plus pelvic floor exercises for 3 months. The combined group did better from week two and reached week ten at 0.09 versus 1.37 on the symptom scale. The outcome was post-micturition dribble, not rigidity, but the muscles trained are the same ones used in an erection.
How long do Kegels take to help someone on tadalafil?
The drug acts in hours; muscle responds to weeks of repetition. In Lavoisier's study (2014), the pressure generated by the ischiocavernosus rose within the first rehabilitation sessions and kept growing across 20 sessions. In Dorey's study (2005), improved rigidity was measured after 3 months of training. The gain shows up gradually and depends on consistency, not intensity.
Conclusion
Tadalafil and Kegels do not compete. The drug opens the door; the muscle closes the exit. A man who relies on the pill alone solves half the problem, which is why the erection sometimes fills but does not hold. The studies show that pelvic floor training improves rigidity in 3 out of 4 men, and that adding training to the drug delivered results where the drug alone fell short.
Talk to your doctor about tadalafil and leave the muscular part to Ritmo: short, guided, progressive sessions built to strengthen what holds the erection while your treatment continues exactly as prescribed.
