Erectile dysfunction common with long-distance cycling
Clinical question
Are there specific bicycle characteristics that modify the risk of
erectile dysfunction?
Bottom line
Long-distance cyclists wishing to minimize 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. (LOE = 2b)
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Reference
Dettori JR, Koepsell TD, Cummings P, Corman JM. Erectile dysfunction
after a long-distance cycling event: associations with bicycle
characteristics. J Urology 2004; 172:637-41.
Study design: Cohort (prospective)
Setting: Population-based
Synopsis
Erectile dysfunction (ED) following long-distance cycling is thought to
be secondary to compression of the neurovascular bundle from sitting on
the saddle. As a result, new bicycle saddles are marketed with "cutouts"
or significant grooves intended to relieve pressure and decrease the
risk of ED. To evaluate potential relationships between ED and various
bicycle characteristics, the authors prospectively studied a cohort of
463 cyclists who participated in 1 of 6 different recreational bicycle
rides of at least 320 kilometers. Subjects were sexually active, 21
years or older, and reported normal erectile function at the onset of
the study. Data were collected 1 week before the event, and 1 week and 1
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. ED was determined using a previously validated International
Index of Erectile Function questionnaire. Follow-up data was available
for 84% of the subjects at 1 week and 74% at 1 month. The cumulative
incidence of ED was 4.2% and 1.8% at 1 week and 1 month after the ride,
respectively. Bicycle characteristics associated with an increased risk
of ED included a mountain bike compared with a road bike (relative risk
[RR] = 4.1; 95% CI, 1.6 - 12.5), and the relative height of the
handlebars parallel with or higher than the saddle compared with a
handlebar height lower than the saddle (RR = 3.0; 95% CI, 1.1 - 9.3).
Nearly one third of participants reported perineal numbness during the
ride which was also associated with an increased risk of ED. In those
subjects reporting perineal numbness, use of saddles with cutouts
actually increased (rather than decreased, as expected by marketing
claims) the risk of ED (RR = 6.0; 95% CI, 1.3 - 27.1). Saddle cutouts
did decrease the risk of ED in subjects not reporting perineal numbness
during the ride. It is uncertain whether patients with a past history of
numbness and ED were more likely to use cutout saddles, possibly biasing
the results. There were insufficient data to determine any association
between ED and saddle width, padding, or tilt.
--
Anthony Cox