Efficacy of pelvic floor muscle training in the management of premature ejaculation: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Premature ejaculation (PE) is a prevalent sexual dysfunction (5%-15%), and pelvic floor muscle training (PFMT) has been proposed as a non-pharmacological alternative to improve intravaginal ejaculatory latency time (IELT). AIM: To evaluate the efficacy of PFMT in the management of PE through a systematic review and meta-analysis of randomized controlled trials. METHODS: Randomized controlled trials involving men diagnosed with PE were included, searched in CINAHL, Clinical Trials, CENTRAL, Embase, MEDLINE, PEDro, SciELO, Scopus, and Web of Science up to October 2025, with no restrictions on time or language. The Rayyan software was used for study screening, and risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool by 2 independent reviewers (F.A.O. and L.B.L.) Statistical analysis was performed using Review Manager 5 with a random-effects model. The primary outcome was IELT, which was reported as both mean and median, and the estimated values were standardized for the meta-analysis. Sensitivity analysis evaluated the impact of heterogeneity and risk of bias on the effect of PFMT. OUTCOMES: Five studies were included in this review and assessed in the meta-analysis. A total of 236 men participated in the studies, and 216 were randomized across the groups included in the meta-analysis. Pelvic floor muscle training and sphincter control training (SCT) showed a smaller effect on IELT compared with control interventions using dapoxetine or combined therapies, with mean differences of -54.09 s (95% CI [-92.13, -16.05]) and -81.44 s (95% CI [-127.54, -35.34]), respectively. Heterogeneity was considered high in the PFMT subgroup (I2 = 75%) and null for the SCT subgroup (I2 = 0%). CONCLUSION: Dapoxetine or the combination of PFMT with an auxiliary masturbation device or diaphragmatic breathing exercises may be superior in improving IELT in men with PE compared with isolated exercise programs.