ORIGINAL RESEARCH—PATHOPHYSIOLOGYORIGINAL RESEARCH—PATHOPHYSIOLOGY: Bicycle Riding and Erectile Dysfunction: An Increase in Interest (and Concern)
Introduction
Our group began investigating the effects of bicycling on male erectile function in the 1980s. Patients seeking treatment for their erectile dysfunction (ED) by microvascular arterial bypass surgery (penile revascularization) frequently provided a history of either blunt penile, pelvic, and/or perineal trauma [1, 2, 3, 4, 5]. A subset of these men, concerned with their ED at a young age (teens to 30 year olds), provided a history of blunt perineal trauma associated with bicycle riding. Histories associated with chronic perineal compression were obtained from avid, competitive cyclists, weekend cyclists, and stationary bicyclists. Daredevil cyclists and preteen novice bicyclists offered histories associated with acute perineal compression related to falls onto the saddle nose or bicycle bar. Over the last 20 years, there appears to be an exponential interest and concern by bicyclists regarding the development of ED.
Other researchers have had similar observations. Since 1981, and particularly in the last 5 years, numerous health‐care professionals from different disciplines, including basic scientists, epidemiologists, engineers, and physicians that included researchers from the National Institute for Occupational and Safety Health (NIOSH), have investigated the association between bicycle riding and ED. The NIOSH investigated the effects of occupational bicycling on erectile function as a result of complaints of groin numbness from concerned police officers who rode in bicycle patrol units.
The overall aim of this literature review was to summarize the accumulating medical data concerning the cause‐and‐effect association between bicycle riding and ED. In epidemiologic studies there are levels of evidence to support the existence of a relationship between two variables (bicycle riding and ED). These include case reports (lowest form of evidence), observational series or small patient series, case control studies, mechanistic studies, and population‐based epidemiological investigation (highest level of evidence). In this literature review on bicycle riding and ED, studies were ranked by level of epidemiologic evidence. A secondary aim of this literature review was to address the concerns of bicycle riders and to propose measures based on evidence‐based literature to minimize the risk of ED associated with bicycle riding.
Section snippets
Case Reports
Case reports, in general, have limited scientific validity but do represent the first line of epidemiologic association in determining cause and effect between two variables. The first case report concerning the association between perineal compression and ED was written in the 4th century bc. Hippocrates wrote that many Scythians reported being impotent because “the constant jolting on their horses unfits them for intercourse.” He continued by saying, “. . . they are the most impotent men”[6].
Observational Series
Small patient series do not have a control population for comparison purposes and thus are subject to bias. Weiss in 1985 reported penile numbness or paresthesias (81%) during an 8‐day, 500‐mile cycling tour [14]. Andersen and Bovim in 1997 studied 260 participants in the 540‐km Norwegian annual bicycle touring race. Thirty‐three of 160 responding males (21%) had penile numbness or hypoesthesia after the tour, with 10 experiencing penile numbness for more than a week. ED was reported by 21
Case Control Studies
In 1997, Salimpour presented at the American Urological Association meeting in San Diego a case control questionnaire‐based study of 738 riders (mean age 44 years) from a local Boston bicycling club compared with an age‐matched (mean age 44 years) 277 runners from a local track and field club. The prevalence of moderate to complete ED (as defined by criteria used in the Massachusetts Male Aging Study) was 4.21% in the rider population and was significantly more common (P = 0.018) than in the
Mechanistic/Pathophysiologic Investigations
Mechanistic studies are important to provide a hypothetical explanation for the pathophysiologic basis of the association between two variables. Concerning bicycle riding and ED, it is hypothesized that straddling bicycle saddles are associated with excessive perineal compressive pressures at the perineal–saddle interface. Measurements that exceed systolic perfusion pressures, which temporarily occlude penile blood flow, have been recorded [21]. It is hypothesized that in some bicyclists
Population‐Based Epidemiological Investigation
To determine the extent, nature, and spectrum of an association between two variables, the highest level of epidemiologic evidence examines data in a population of random sampled, free‐living individuals who enter the trial free of biases that typically plague case control studies. The only population‐based epidemiologic study thus far that examined the association of bicycle riding and ED was carried out by Marceau et al. in 2001. The authors of that research evaluated data from the
Discussion
Riding a bicycle is a common mode of transportation used by more than 50 million people in the United States [36] and by an estimated more than 1 billion men and women around the world. Bicycle riding is also an excellent form of cardiovascular exercise. The average MET level and caloric cost for leisure and moderate cycling is 4.0 METs and 280 cal/hour and 5.7 METs and 400 cal/hour, respectively [37]. Aerobic exercise (energy expenditure of 7.5 kcal/minute) from cycling can halve the risk of
Conclusion
The association between bicycle riding and ED has been well documented in numerous case reports [6, 7, 8, 9, 10, 11, 12, 13], observational series [14, 15, 16], case control studies [17, 18, 19, 20], and population‐based epidemiologic investigations [35]. It is believed that ED secondary to bicycling may be explained by how the rider interacts with the bicycle saddle. Straddling bicycle saddles is associated with perineal compressive pressures that exceed systolic perfusion pressures,
Conflict of Interest
None.
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Cited by (37)
Systematic Review and Meta-Analysis of Cycling and Erectile Dysfunction
2021, Sexual Medicine ReviewsCitation Excerpt :Blunt perineal trauma by several mechanisms, including bicycle accidents, can lead to arterial occlusive disease and subsequent impotence.31 It has been hypothesized that perineal compression from cycling may cause ED through a similar mechanism of endothelial injury and arterial insufficiency,32 along with chronic hypoxemia and corporal fibrosis.33 However, the extent to which chronic perineal compression results in vascular and neurogenic changes comparable with traumatic injury remains unclear.
Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists
2019, Journal of Sexual MedicineBritish Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction in Men—2017
2018, Journal of Sexual MedicineCitation Excerpt :This may produce a neuropraxia, which is occasionally persistent but usually reversible or vascular endothelial injury and vasculogenic ED. Questions about bike riding should be considered, especially in young men with no clear cause of ED.91,92 There is no role for venous ligation unless an isolated venous anomaly can be demonstrated on cavernosography.93
Bicycle Riding and Erectile Dysfunction: A Review
2010, Journal of Sexual MedicineCitation Excerpt :Cyclists should avoid staying seated for long periods and restrict their training intensity by taking frequent breaks [34]. Standing on the pedals during long rides can relieve pressure and help re-establish blood flow [50]. In conclusion, bicycle riders should: (i) choose a wide, unpadded no-nose saddle that allows proper placement of the sit bones; (ii) choose a horizontal saddle position; (iii) ride in a more upright position; (iv) change their body position regularly from a seated to a standing position; and (iv) use road bicycles instead of mountain bikes.
Letter to the Editor
2010, Applied ErgonomicsBicycle riding may cause erectile dysfunction
2009, Medical Hypotheses