Youthful drivers may have the urge to put the pedal to the metal, but older cyclists might want to pause before putting pelvis to the saddle. The bicycle saddle, that is.

An online Urology Times article presents the impact of bike riding on men’s health.^[i] On the plus side, there are many compelling benefits, including cardiovascular fitness, weight reduction, metabolic fitness that helps prevent diabetes, and reduced risk of stroke. I have even written about evidence that exercising the muscles of the legs indirectly boosts brain health. So, how can you go wrong with cycling?

Well, when it comes to men’s pelvic health, there is a downside due to the pressure of the bike seat on the pelvic floor. An earlier blog of mine explained the connection between bike riding and prostatitis, a common irritation of the prostate. As the Urology Times piece explains, the pelvic floor and perineum (outer skin between the scrotum and anus) are vulnerable to the uneven or unbalanced pressure. Because much level one research is lacking, Awad et al. (2018)^[ii] designed and implemented a questionnaire-based study comparing urinary/sexual function between cyclists vs. swimmers and runners. Nearly 4,000 survey responses (3,932) were included in their final analysis.

Study results

Based on questionnaire responses, the research team did not find a significant difference in sexual or erectile dysfunction between the two groups. However, they found that cyclists had a significantly higher risk of a specific type of injury to the urethra (passage that carries urine out of the body from the bladder through the prostate gland and penis) as well as genital numbness and saddle sores.

• The injury is called a urethral stricture, that is, a narrowing of the urinary passage due to formation of scar tissue. When this occurs, urinary symptoms may include retention of urine in the bladder, weak or spraying stream, greater urgency to urinate, difficult or painful urination, and even increased chance of lower urinary tract infections.
• The genital numbness may be attributed to bike seat pressure on the pudendal nerve, which is the main nerve in the perineum. This nerve transmits sensation from the outer genitals and the skin around the anus and perineum, and is also involved in the use and movement of several pelvic and excretion-related muscles.

The degree or severity of numbness correlates with the number of years the person had been cycling, the greater the frequency during the week, and the longer the biking distance. It is worth noting that genital numbness appeared to have no connection with erectile dysfunction (ED); bikers who experienced numbness and those who did not had equivalent average sexual scores. However, those whose numbness was primarily over the buttocks reported worse sexual function than those who didn’t.

How cyclists can protect urologic health

In terms of preventing pelvic floor stress during bike riding, the study authors particularly focused on compromising the pudendal nerve due to constant pressure shifts on the perineum. They rigged up a stationary bike with a pressure sensitive seat, and a way to mimic the forces of navigating real-world biking terrain. This generated a computer model of the pressure distribution on the perineum and pudendal nerve. They suggested that seat-post shock absorbers would be much kinder on a rider’s bottom in terms of minimizing trauma.

Stating that common sense dictates avoiding numbness whenever possible, they advise both leisure and serious cyclists to seek a professional bicycle fit in order to optimize ergonomics and reduce nerve and urethral damage. This includes not only seat modifications and shock absorbers, but also adjusting handlebars to a height “at least even with the saddle.” According to their observations, “Riding a bike that fits well is likely the single most important step riders can take to protect themselves from genital numbness.”^[iii]

Research into bike riding and men’s pelvic health, both urinary and sexual, is a work in progress. We probably have much to learn from societies in which bike riding is part of daily life, such as the Dutch in Amsterdam or many cities in China. Until then, studies like the Awad paper remind us that no matter what form of regular workouts we choose, learning how to protect the parts of the body most vulnerable to repetitive use is key to maintaining a safe and healthy exercise routine.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Lee, Austin & Breyer, Benjamin MD. “Bicycle Riding: Good or Bad for Men’s Health?” Urology Times, Vol. 48, Issue 03. March 11. 2020. https://www.urologytimes.com/mens-health/bicycle-riding-good-or-bad-mens-health
[ii] Awad MA, Gaither TW, Murphy GP, et al. Cycling, and Male Sexual and Urinary Function: Results from a Large, Multinational, Cross-Sectional Study. J Urol. 2018;199(3):798?804. doi:10.1016/j.juro.2017.10.017
[iii] Lee & Breyer, ibid.