Erectile dysfunction is common with long distance cycling

Question Are there specific bicycle characteristics that modify the risk of erectile dysfunction?

Synopsis Erectile dysfunction after long distance cycling is thought to be secondary to compression of the neurovascular bundle from sitting on the saddle. As a result, bicycle saddles with “cutouts” or grooves intended to relieve pressure and decrease the risk of erectile dysfunction have become available. To evaluate potential relationships between erectile dysfunction and various bicycle characteristics, the authors prospectively studied a cohort of 463 cyclists who participated in one of six different recreational bicycle rides of at least 320 km. Subjects were sexually active, 21 years or older, and reported normal erectile function at the onset of the study. Data were collected one week before the event and one week and one month after the event. The style of saddle containing a deep split in the back and a groove down the middle was classified as a saddle with a cutout. Erectile dysfunction was determined by using a previously validated international index of erectile function questionnaire. Follow up data were available for 84% of the subjects at one week and 74% at one month. The cumulative incidence of erectile dysfunction was 4.2% at one week and 1.8% at one month after the ride. Bicycle characteristics associated with an increased risk of erectile dysfunction were a mountain bike compared with a road bike (relative risk (RR) 4.1; 95% confidence interval 1.6 to 12.5) and handlebars as high as or higher than the saddle compared with lower than the saddle (RR 3.0; 1.1 to 9.3). Nearly one third of participants reported perineal numbness during the ride and this was also associated with an increased risk of erectile dysfunction. In subjects reporting perineal numbness, use of saddles with cutouts increased (rather than decreased, as expected by marketing claims) the risk of erectile dysfunction (RR 6.0; 1.3 to 27.1). Saddle cutouts decreased the risk of erectile dysfunction in subjects not reporting perineal numbness during the ride. It is uncertain whether patients with a history of numbness and erectile dysfunction were more likely to use cutout saddles, possibly biasing the results. Data were insufficient to determine any association between erectile dysfunction and saddle width, padding, or tilt.

Bottom line Long distance cyclists wishing to minimise the risk of erectile dysfunction should ride a road bicycle instead of a mountain bicycle, keep the handlebar height lower than saddle height, and use a saddle without a cutout if perineal numbness is experienced.

Level of evidence 2b (see www.infopoems.com/levels/html). Individual cohort study or low quality randomised controlled trials < 80% follow up.