Effect of Yoga in Premature Ejaculation: A Systemic Review and Meta-analysis

Abstract

Premature ejaculation (PME) is one of the most common male sexual disorders, affecting 20-30% of men globally. While various treatments exist, including pharmacological interventions, there is growing interest in yoga as a non-pharmacological approach. This systematic review and meta-analyse evaluated the effectiveness of yoga interventions for premature ejaculation. A systematic search was conducted across PubMed/Medline, EMBASE, Scopus, Google Scholar, and Web of Science databases from 1990 to January 2025. Studies comparing yoga interventions for PME were included, and data was analysed using random effects model. Five studies met inclusion criteria, with three providing data suitable for meta-analysis. The meta-analysis showed a significant positive effect of yoga interventions (SMD = 1.74, 95% CI: 1.27-2.22), though with high heterogeneity (I² = 90.7%). One study comparing yoga with fluoxetine showed greater IELT improvement in the yoga group (79.6 vs 34.2 seconds). Studies comparing yoga with non-pharmacological interventions also demonstrated favourable outcomes for yoga. Importantly, no significant adverse effects were reported in yoga groups, while pharmacological interventions showed side effects in up to 46.4% of participants. Yoga appears to be a promising intervention for PME, potentially working through stress reduction, autonomic nervous system modulation, and pelvic floor strengthening. However, the evidence is limited by small sample sizes and methodological heterogeneity. Larger, well-designed randomized controlled trials are needed to establish yoga's efficacy as a standard treatment option for PME.

Introduction

There is no fixed time limit or set criterion when a man should normally ejaculate during sexual intercourse, but it is agreed that it will be considered too early if it happens either before or soon after starting, resulting in men losing erection and unable to continue intercourse. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)[1] defines PME as “A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within or approximately 1 min following vaginal penetration and before the individual wishes it.[2,3] This symptom must have been present for at least 6 months and must experience on almost all (approximately 75%−100%) occasions of sexual activity. It causes clinically significant distress in the individual.”[4] PME has also been divided into two categories – lifelong and acquired.[5]

International Society for Sexual Medicine in April 2013 convened a second ad hoc committee in Bangalore, India, to develop a unanimously agreed definition of premature ejaculation (PME) by following an evidence-based systematic approach to literature search, retrieval, and evaluation. They concluded that both acquired and lifelong PME have common features of decreased latency for ejaculation, perception of either reduced or absent control over ejaculation, and adverse consequence on personal life. It was unanimously agreed that the PME will be defined as (i) ejaculation that always or nearly always occurs prior to or within about 1 min of vaginal penetration from the first sexual experience (lifelong Pre-ejaculation [PE]) or a clinically significant and bothersome reduction in latency time, often to about 3 min or less (acquired PE), (ii) the inability to delay ejaculation on all or nearly all vaginal penetrations, and (iii) negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.[6]

There is variation in the prevalence of PME reported by different studies. This could be because of different definitions used for PME, studying acquired and lifelong PME separately, different methods of measuring ejaculatory time (self-reported or stopwatch technique), etc. Despite studies differing in their methodology and designs, it is commonly agreed that it is one of the most common sexual problems faced by men with negative consequences on different aspects of men’s life. Patients with PME have three levels of burden: (i) emotional, (ii) health, and (iii) burden on the relationship.[7] It negatively impacts many aspects of man’s life, including reducing self-esteem, deteriorating relationships, and causing anxiety, embarrassment, and depressed feelings.[8] A multinational survey conducted in a large population of 12,133 showed the prevalence of PME at 24.0% in the United States, 20.3% in Germany, and 20.0% in Italy.[9] A Southeast Asian study exploring various types of sexual problems has found early ejaculation to be the most common complaint reported by 31% of men interviewed.[10]

Indian studies among patients attending the clinic for sexual problems in a tertiary care center among patients have reported the prevalence of 30% and 77.6%, respectively, in eastern India in Kolkata and North India in AIIMS, Delhi, and conducted among 1000 men attending sex therapy clinic in a tertiary care center, AIIMS, Delhi, among 77.7% of patient reported of having the problem of PME.[11] Indian studies conducted in the community of rural areas of Haryana and Mysore have reported a prevalence of 4.6% and 8.76%, respectively.[12,13]

Various theories have been proposed to explain the etiology of PME. Biological theories emphasize the role of neurotransmitters, particularly serotonin.[14,15] It is assumed that individuals with PME are genetically predisposed with impairment in the inhibition serotonergic pathway modulated by 5HT2c, 5HT1a, and 5HT1b receptors, and synaptic serotonin transporters.[16,17] Psychological theories explain PME based on sexual performance anxiety, marital relationship problems, and hyposexual.[5]

There are varieties of treatment options available for PME. Among pharmacological methods, selective serotonin reuptake inhibitors, local anesthetics, and phosphodiesterase inhibitors are the most commonly used drugs.[18,19] Pelvic floor exercises and pause-squeeze technique are the nonpharmacological methods for the treatment of PME.[20] Drug therapy may have a variety of side effects such as headache, nausea, nasal congestion, flushing, dizziness, fatigue, and constipation.[19,21] Although effective in increasing ejaculation time, the use of drug can affect other phases of the sexual cycle and adversely affect the overall sexual experience. For example, local anesthetics, when used for PMR, work quickly, but at the same time, it can cause anorgasmia in both males and females because of penile hypoesthesia and vaginal numbness. Psychological therapies such as psychoanalytical and behavioral therapy have not been found much effective for PME.[22]

Yoga is a very ancient interdisciplinary system of India and has been in practice from 2700 BC. Yoga therapy is defined as a form of treatment to practice meditation, breath work, and asanas or poses with the goals of improving mental and physical health in a holistic way.[23] National Institutes of Health has recently reported that among natural and complementary therapies, yoga has the highest potential for the growth.[13,24] This study aims to evaluate the efficacy of yoga therapy on PME. There are only a few studies which have shown the effectiveness of Yoga in PME, and those compared its effects to other therapies are very limited in number.

Methods

Search strategy

In the present study, we conducted a systematic review and meta-analysis of existing literature to identify all the relevant publications comparing the outcomes of yoga. A systematic literature search from related papers was performed according to “Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement” (PRISMA),[25] following various electronic databases: PubMed/Medline, Embase, Scopus, Google Scholar, and Web of Science by authors independently. The study was preregistered in the International Prospective Register of Systematic Reviews with ID CRD42020186868 (19/04/2021). MeSH terms used for the search were according to patient, intervention, and outcome guidelines, i.e., “Yoga” OR “Yog” OR “asana” OR “mudra” OR “Kapalbhati” AND “premature ejaculation” OR “ejaculation” OR “ejaculation time” OR “Shukragata Vata” OR “Shukragatavata.” The following filters for the search were applied: date of publication (January 01, 1990, and onward), sex (males), species (human), and language (English). The last systematic search was performed on January 30, 2025.

Selection criteria

Authors independently reviewed the titles and abstracts of the relevant articles obtained from the literature search. Based on the inclusion and exclusion criteria, studies were selected for full-text review. Studies reporting individualized data on the comparison of yoga with others within the same manuscript were included, whereas studies including patients without PME, reviews, and case reports were excluded. Any discrepancy on the inclusion or exclusion of a study was sorted out by arbitration among the authors.

Data extraction

Using a predefined template [Table 1], author, year of publication, yoga intervention, control group, outcome measure, and result by reviewers from the studies included in the final analysis. In case of any discrepancy, the help of other authors was sought for arbitration.

Table 1.

Summary of data of studies

Study author and year	Participants	Yoga intervention	Control	Outcome measure result
Vikas Dhikav et al., 2007[40]	68 males Outpatient department of a tertiary care psychiatric hospital in Delhi, India	12 asanas 2 pranayamas Mebabbed mudra differential relaxation	Fluoxetine - 20–60 mg	IELT Mean IELT in yoga group improved from 33.2±17.9 to 112.8±35.6 s (P<0.0001) Mean IELT in fluoxetine group improved from 29.9±15.1. to 64.1±29.4 s (P<0.0001)
Vikas Dhikav et al., 2010[43]	65 males Enrolled from yoga camp in Mumbai, India	18 asanas AV pranayama Mudra (Ashwini) Bandha (Uddiyana) Cleansing process (Kapalbhati)	No control group	MSQ MSQ scores improved in all aspects Mean MSQ score improved from 66.37 to 78.20 (P<0.0001) Mean score of ejaculatory control improved from 2.54 to 3.57 (P<0.0001)
Makwana JJ and Patil PJ 2012[44]	30 males Psychiatry department of medical college, Dhule, Maharashtra, India	7 asanas 2 mudra pranayama	Stop–start technique	IELT Mean IELT improved in yoga group from 73.87±7.3 to 125.6±3.9 s (P<0.0001) Mean IELT improved in start–stop technique group from 73.4±4.3 to 97.1±3.9 s (P<0.0001)
Patil P et al., 2012[41]	30 males Physiology Department of Shri Bhausaheb Hire Medical College, Dhule, India	Sitting yoga/mudras Yoga mudra Supta Vajrasana Matsyasana Paschimottanasana Ashwini mudra	Nonsitting yoga Supine Shalabhasana Naukasana Standing Hastapadasana Trikonasana Pranayama Inverted Sarvangasana	IELT Mean IELT improved in sitting yoga group from 75.7±6.5 to 128.6±5.6 s Mean IELT improved in nonsitting yoga group from 77.4±6.7 to 106.4±3.4 s
Mamidi P and Gupta K, 2013[42]	12 males Outpatient department of MPIYNER, Gujarat Ayurved University Campus, Jamnagar, Gujarat, India	Loosening exercises (stretches and rotations) Suryanamaskara (Sun Salutation) 16 asanas Moolabandha (perineal contraction pose) Vajroli mudra (thunderbolt attitude) AV pranayama (alternate nostril breathing) Agnisar pranayama (activating digestive fire)	Naturopathy Massage of lower abdomen and lower limbs Steam Sitz bath Mud pack on lower abdomen acupressure	PESI Mean PESI score improved from 65.8 to 61 in yoga group (P<0.01) Mean PESI score improved from 66.6 to 65 in naturopathy group (P>0.05) No significant difference (P>0.05) found between the two groups The overall effect of both therapy was “unchanged” or “no relief” (<25% relief)

MPIYNER: Maharshi Patanjali Institute of Yoga and Naturopathy Education and Research, AV: Anuloma Viloma, MSQ: Male sexual quotient, IELT: Intravaginal ejaculation latency time, PESI: Premature Ejaculation Severity Index

Risk-of-bias assessment

The risk-of-bias assessment [Figure 1] evaluates three studies across five key domains of potential bias. In this visualization, each domain was assessed using a simple color-coded system where green plus signs (+) indicate “low” risk and yellow minus signs (−) indicate “some concerns.” The assessment reveals that Study 1 demonstrates exemplary quality with low risk across all domains. Study 2 shows strong performance with only one concern in the randomization process, while Study 3 has a notable concern in missing outcome data. This suggests that while there are some methodological concerns, the overall quality of the studies is generally good, with specific areas identified for improvement in future research, particularly in randomization processes and handling of missing data. The predominance of green indicators (+) across domains suggests that these studies generally maintained good methodological rigor, though not perfect, in their execution and reporting.

Figure 1.

(a) Traffic light (b) Weighted bar risk-of-bias plots of included studies

Statistical analysis

All the relevant data pertaining to the study were entered into a Microsoft Excel sheet. While performing the pooled analysis, a weighted average of the individual summary statistics was calculated for the duration of follow-up and yoga characteristics in the two groups. The mean was estimated from the median and range using the reported formula.[26] Statistical heterogeneity was tested using the Chi-square and I². The random effects model was used as it provided a more conservative approach. P ≤ 0.05 indicated statistical significance. Statistical analysis was performed using the STATA 16.0 (Stata Corp., TX, USA).

Results

The PRISMA flow diagram [Figure 2] in the document visually represents the systematic review process, detailing the identification, screening, eligibility, and inclusion of studies. Initially, 3157 records were identified through database searches, with an additional 806 records sourced from other references, bringing the total to 3174 after removing duplicates. During the screening phase, 2167 records were reviewed, with 1537 excluded based on title, abstract, and language criteria. Of the 630 full-text articles assessed for eligibility, 399 were excluded for meta-analysis and review, 160 for being nonrandomized controlled trials, 13 for being books or chapters, and 53 for other reasons, totaling 159 exclusions. Our literature review identified five original studies that evaluated yoga’s effect on PME. Only three studies used intravaginal ejaculation latency time (IELT) as an outcome measure, while two studies relied on questionnaires – the Male Sexual Quotient (MSQ) and the Premature Ejaculation Severity Index (PESI) – without measuring ejaculation time directly. Sample sizes were relatively small, ranging from 12 to 68 total participants, with 6–38 participants per study arm.

Figure 2.

Study flow diagram of the selection process for the studies included in this systematic review and meta-analysis. RCT: Randomized controlled trial

The studies varied in design and methodology. Only three studies used randomization when allocating participants between two interventions. Among the comparative studies, one compared yoga to pharmacological treatment (without randomization), two compared yoga to nonpharmacological interventions, and one compared two different types of yoga [Figure 3]. The specific yoga postures used are illustrated and detailed in Table 2. Only two studies reported on side effects, noting no significant adverse effects or dropouts. All studies except one concluded that yoga was an effective intervention for PME.

Figure 3.

Yoga techniques to improve premature ejaculation. (a) Kapalbhati, (b) Pranayama, (c) Yog mudra (d) Vajarasan (e) Bhujangasan (f) Dhanurasan (g) Halasan (h) Paschimottoasana (i) Ardhmatsyendra mudra (j) Sarvang asana (k) Shava asana (l) Bhushirasana (m) Marjarasan (n) Hansasana (o) Pavanmukatasan (p) Chakarasan (q) Trikonasana (r) Paravatasan (s) Viparita karani mudra (t) Matsyasana (u) Ardhmatsyendra mudra (v) Paschimottoasana (w) Bhujangasan (x) Dhanurasan (y) Shalabhasan (z) Naukasana

Table 2.

Yoga postures used in trials to effect on premature ejaculation

Name of Mudra	Etymology	Description
Kapalbhatia	Kapal=Skull, bhati=Bright; “forehead brightener”	Sit straight in squatting posture with eyes closed. Put hands on the knees. Fix the chest and consciously contract abdominal muscles
Pranayamab	Breath control	Sit comfortably with eyes closed in squatting posture. Deep breathing should be done through alternating nostrils as shown
Vajarasanad	Vajra=Diamond	Fold legs at knee joints and sit on the legs, and touch knee caps as shown
Yog mudrac	Mudra=Posture	Take hands to the lower back. Catch the right wrist with the left palm and bend forward
Bhujangasanae	Bhujang=Snake, asana=Posture; serpent-like posture	Lie down in prone position and transfer weight on palms. Attempt should be made to stretch the back muscles
Dhanurasanax	Dhanu=Bow, asana=Posture	Body gets a “bow-like shape”
Paschimottanasanah	Paschim=Working on posterior	Sit with legs straight, touch toes, and try to bend the head forward and kiss the toes
Ardhmatsyendra mudrau	Ardha=Half, matsyenddra=Name of a yogic practitioner, mudra=Posture; “half spinal twisting” exercises	Sit straight, bend the right knee, and put it below buttocks. Now cross the left leg and bring it in front of the right knee
Sarvangasanaj	“Shoulder stand”	Lie down straight and gradually lift legs. Then, once adequate lift is achieved; support the pelvis and lower back with the palms of both hands
Halasanag	“Plow posture”	Lie down flat; then, turn legs overhead while maintaining hands on the ground firmly
Marjarasanm	Cat’s posture	Sit in Vajarasana and after that be in the cat’s posture and move the spine and neck
Pawanmuktasanao	Hanging in air	Lie down on your back, bend the legs, bring them inside; clasp them with the hands. Now, bring the head up to touch the knee as shown
Matsyasanat	Fish’s posture	Lie down flat on the back and bend the neck backward
Paravatasanr	Parvata=Mountain; mountain pose	Sitting with head and spine intact with hands stretched overhead like a mountain
Viparita Karani mudras	Viprit=Opposite, mudra=Posture	“legs-up-the-wall pose”
Shalabhasanay	Locust pose	Lie down on your chest and rest the head on ground. Lift the legs to the extent that the entire body rest on the chest and abdomen. Keep hands firm on ground
Naukasanaz	Nauka=Boat; boat posture	Lying prone and lifting hands and legs in air
Bhushirasanal	Preliminary posture of Shirshasana	Sit in Vajrasana and touch the head on floor with the help of wall
Hansasanan	Prelimnary posture of Mayurasana	Sit in Vajrasana and transfer your weight on both palms. The body will hang in air, but the feet are supported by ground. It gives all the benefits of Mayurasana without difficulty. Particularly suited for overweight or old people
Chakarasanap	Wheal pose	This asana is so named because the body takes the shape of a circle or a semicircle
Trikonasanaq	Triangle pose	Stand up, open the legs, touch the right leg with the right hand, and move the left arm in air. Look toward the fingertips of the left hand
Uddiyana bandha/agnisarau	Agni=Heat A series of rapid “abdominal lifts”	Exhale out all air and then draw abdominal muscles under the rib cage
Shavasanak	Dead posture	It involves lying relaxed, eyes closed, with arms placed on both sides of the body
Dhanurasanaf	Dhanur = Bow, Asana = Posture	The body takes the shape of a drawn bow. Practiced lying on the stomach, lifting chest and legs while holding ankles. Strengthens back, opens chest.
Ardha Matsyendrasanai	Ardha = Half, Matsyendra = Sage/King of Fishes, Asana = Posture	A seated spinal twist that tones abdominal organs and increases spinal flexibility. Named after Sage Matsyendra.
Paschimottanasanav	Paschima = West/Back, Uttana = Intense Stretch, Asana = Posture	Performed by bending forward over extended legs. Stretches spine and hamstrings, improves digestion, calms the mind.
Bhujangasanaw	Bhujanga = Cobra, Asana = Posture	Lying on the belly and lifting the chest with arms. Mimics a cobra. Strengthens spine, opens chest, and improves flexibility.

^aKapalbhati, ^bPranayama, ^cYog mudra, ^dVajarasan, ^eBhujangasan, ^fDhanurasan, ^gHalasan, ^hPaschimottoasana, ⁱArdhmatsyendra mudra, ^jSarvang asana, ^kShava asana, ^lBhushirasana, ^mMarjarasan, ⁿHansasana, ^oPavanmukatasan, ^pChakarasan, ^qTrikonasana, ^rParavatasan, ^sViparita karani mudra, ^tMatsyasana, ^uArdhmatsyendra mudra, ^vPaschimottoasana, ^wBhujangasan, ^xDhanurasan, ^yShalabhasan, ^zNaukasana

The forest plot presents a meta-analysis of three studies [Figure 4] examining yoga’s effectiveness for PME. The meta-analysis demonstrates a significant positive overall effect of the interventions studied, with a standardized mean difference (SMD) of 1.74 (95% confidence interval [CI]: 1.27–2.22), as indicated by the diamond in the forest plot. All individual studies show positive effects, with SMD values >0, and their confidence intervals do not cross zero, confirming statistically significant outcomes. However, the I² of 90.7% indicates high heterogeneity among the studies, suggesting substantial variability in methodologies, populations, or interventions. This is further supported by the P value for heterogeneity (P = 0.000), highlighting significant inconsistency. While the findings suggest that the interventions, likely yoga or other nonpharmacological methods, are effective in managing PME, the considerable heterogeneity necessitates caution in generalizing the results.

Figure 4.

Study forest plot summarizing the quantitative result. CI: Confidence interval

Discussion

Mechanism of yoga

Yoga is a discipline to improve or develop one’s inherent power in a balanced manner. Yoga therapy is a form of treatment to practice meditation, breath work, and asanas or poses with the goals of improving mental and physical health in a holistic way.[23] Yoga is a very useful nonpharmacological therapy system that works on holistic aspects of health, physical, mental, social, and spiritual. Yoga has been found useful for a variety of medical problems. It has been claimed to be effective for sexual problems as well. However, the exact mechanism of how it works to improve PME is not yet clear.[27]

In Tantric and Taoist traditions of yoga mentioned concept of Kundalini which include seven chakras, related practices to kundalini improving sexuality in humankind.[28] One explanation of behind positive effect of yoga on male sexual function could be because of its beneficial effect of anxiety and stress. Studies both in India and other countries have reported that yoga triggers neurohormonal mechanisms, leading to reduction in the level of stress and thus improving sexual health.[29,30] Yoga enhances autonomic function with stimulating neurohormonal mechanism by suppression of sympathetic activity.[31,32]

Direct effects of yoga on sexual functions could be because of its effect of suppressing sympathetic activity and activating parasympathetic activity and increasing in the level of serotonin 5-hydroxytryptamine (5-HT). Both these changes from yoga practice reduce contractions in the epididymis, ejaculatory ducts, and seminal vesicles, which helps enhance ejaculatory control through increased parasympathetic activation.[29,31,33,34] There is lot of literature discussing mechanism and effect of yoga on sexual functioning in males. Majority of them have also discussed how yoga improves PME. However, there are very few original studies which assessed yoga’s effect on PME.

Focused attention on lower abdominal breathing movements is associated with significant increases in whole blood serotonin (5-HT) levels. This is noteworthy because the pathophysiology of PME is thought to involve serotonin, with higher 5-HT concentrations playing an important role in maintaining ejaculatory control.[35]

A meta-analysis was conducted in the present study to examine yoga’s effectiveness for PME. The analysis demonstrates a significantly positive overall effect favoring yoga interventions (SMD = 1.74, 95% CI: 1.27–2.22). Among the individual studies, Makwana et al. (2012) showed the strongest effect (SMD = 3.66, 95% CI: 2.46–4.85), followed by Patil et al. (2012) (SMD = 2.81, 95% CI: 1.78–3.84), while Kulkarani et al. (2013) demonstrated a moderate effect (SMD = 0.91, 95% CI: 0.32–1.51). Despite the positive findings [Figure 4], there was substantial heterogeneity between studies (I² = 90.7%, P = 0), suggesting considerable variation in the intervention effects. Kulkarani et al carried the highest weight (63.17%) in the meta-analysis, followed by Patil et al (21.19%) and Makwana et al (15.63%). These results provide statistical evidence supporting yoga as a potentially effective treatment for PME, though the high heterogeneity suggests that benefits may vary across different yoga protocols or patient populations.

There are various tools to assess severity of PME such as PEDT and PESI. However, IELT is considered the gold standard to assess the effect of any intervention PME in trials, which was followed in the eligible studies.[36,37] While one study had a sample size of 68, the other two studies had 30 each. Therefore, available literature has only a total of 128 patients in which the effect of yoga on PME was measured using IELT. The remaining two studies used questionnaire to compare yoga with other interventions and did not measure ejaculation time. In summary, there is a scarcity of data for yoga’s effect on ejaculation time in patients with PME. Although PME is assessed on three aspects, ejaculatory control, ejaculatory time, and distress, most definitions and diagnostic criteria of PME are based on ejaculation time. Double-blinded randomized control trial is considered an appropriate methodology to compare and establish the effectiveness of any new intervention compared to existing methods of treatment for the disorder.[38] Blinding is a difficult process in any trial using yoga as intervention.[39] Our search did not yield any research of yoga which used blinding in their methodology. There were three studies which used randomization for participant’s allocation to groups. One of them compared sitting yoga with nonsitting yoga. The remaining two compared yoga to another nonpharmacological intervention. There was small sample size in these studies either 6 or 15 participants in each arm. Only available study which compared yoga to drug (fluoxetine) did not apply randomization, and patients were asked to choose intervention according to their choice. Except one study, all found that yoga is an effective intervention for the treatment of PME.

Yoga versus pharmacotherapy

Only one study compared yoga with pharmacological treatment for PME. This nonrandomized study allowed patients to choose between two interventions: a yoga program comprising 12 asanas and 3 pranayama exercises (n = 38) or fluoxetine at doses of 20–60 mg daily (n = 30). After 12 weeks, both the groups showed significant improvements in IELT. While the yoga group demonstrated a greater increase in IELT compared to the fluoxetine group (79.6 s versus 34.2 s), the onset of improvement was delayed in the yoga group, becoming apparent only after 8 weeks of practice.[40]

Yoga versus nonpharmacological intervention

In one of the randomized studies comparing yoga to the stop–start technique for PME, 30 participants were divided equally between the two groups. The yoga group practiced seven asanas, two mudras, and pranayama for 3 months, while the stop–start group applied their technique before sexual activity. After 3 months, the yoga group showed greater improvement in ejaculation time (51.73 ± 7.72 s) compared to the stop–start group (23.73 ± 7.6 s).[41]

Another, a 3-week pilot study compared yoga and naturopathy treatments for PME, with six participants randomly assigned to each group. The yoga group performed various exercises including Suryanamaskara, 16 asanas, and specific pranayama techniques, while the naturopathy group received treatments including massage, steam therapy, sitz bath, mud packs, and acupressure. Although both the groups showed improvement in the PESI, only the yoga group’s improvement was statistically significant (4.83 ± 3.65, P < 0.01 vs. 1.66 ± 2.06, P > 0.05). The greatest improvement was in intercourse duration (14.6% for yoga vs. 7.8% for naturopathy), though the difference between the groups was not statistically significant.[42]

Sitting versus Non-Sitting Yoga

Engaging in yoga enhances overall physical capabilities, including stamina, strength, flexibility, muscle tone, and endurance, while also developing core stability. The specific postures in yoga practice help cultivate control over the pelvic and perineal muscles, leading to improved muscular contractions in these areas.[42] The study compared the effects of sitting yoga and nonsitting yoga in patients with PME. The sitting yoga group practiced mudras, three asanas in sitting positions, and pranayama, while the nonsitting yoga group performed two asanas in supine positions, three in standing positions, and one in an inverted position. Each group consisted of 15 participants who were followed for 3 months. Both groups showed significant improvement in IELT following their respective interventions. However, the sitting yoga group demonstrated a greater mean increase in IELT (52.9 ± 7.75 s) compared to the nonsitting yoga group (29 ± 9.2 s).[41]

Yoga in open-label noncomparative trial

A noncomparative pilot study involved 65 healthy, sexually active men who participated in a 12-week yoga program without a control group for comparison. The program included 18 yoga poses (asanas), breathing exercises (Anuloma Viloma Pranayama and Kapalbhati), 2 hand gestures (mudras), and an abdominal lock technique (Uddiyana Bandha). Using the MSQ to measure sexual function, researchers found significant improvements. The average MSQ score increased from 66.37 (±10.9) to 78.2 (±6.07), with statistical significance (P < 0.001). Notably, participants’ ability to control ejaculation improved by 20.6%, with scores rising from 2.54 (±0.92) to 3.57 (±0.5), also showing statistical significance (P < 0.001).[43] Yoga improves sexual health by regulating hormones, maintaining testosterone levels, enhancing reproductive function, elevating mood, and reducing stress.[34]

Application and complication/side effects of yoga in premature ejaculation

In the comparative trial of yoga with fluoxetine showed, up to 46.4% of participants reported side effects such as nausea, vomiting, anxiety, and insomnia with the use of drug. In yoga group, no significant side effect or any dropout was seen.[40] In the pilot study of yoga comparing with naturopathy, no significant side effects or dropout were reported in both the groups.[42]

Conclusion

PME significantly affects men’s well-being and relationships. This review highlights yoga as a potential nonpharmacological intervention, improving ejaculatory control, IELT, and reducing distress. Yoga may work by reducing stress, balancing the autonomic nervous system, and enhancing pelvic floor strength. However, limitations include small sample sizes, inconsistent methodologies, and a lack of standardized yoga protocols. Larger, well-designed studies are needed to confirm efficacy. Given yoga’s safety and broader health benefits, it remains a promising holistic approach for managing PME.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.