madman
Super Moderator
Abstract
Introduction Perineal pressure associated with bicycle riding is the cause of several genitourinary pathologies, most notably Alcock’s syndrome, and subsequent perineal numbness. The possible link between cycling-induced perineal numbness and erectile dysfunction makes the development of strategies for perineal protection in bicycle users critical.
Objective To assess the effectiveness of strategies for reducing the impact of cycling on the perineum in healthy males. Methods We have conducted a systematic review and a meta-analysis of studies examining various means of reducing the impact of cycling on the perineum under the PRISMA guidelines.
Results Out of 2217 screened studies, 22 met our inclusion criteria and 6 qualified for meta-analysis. The strategies included various designs of saddles, changes in the cycling position, seat shock absorber, shorts with different padding, using the recumbent bike. Using the no-nose saddle and recumbent bike resulted in a significant reduction of perineal pressure and higher penile oxygen pressure compared with a standard saddle. Indirect evidence supports the protective effect of standing on the pedals every few minutes during cycling. More evidence is needed to support—or dismiss—other strategies.
Conclusions Current evidence supports the use of no-nose saddles as a means to reduce the negative impact of cycling on the perineum in healthy males at the cost of worse stability and an increase of posterior seat pressure. Standing on the pedals every ten minutes might be an effective and potentially widely applicable strategy. The use of a recumbent bike appears to protect the perineum, but several concerns prevent its widespread use.
1 Introduction
Cycling is one of the most commonly used cardiovascular exercises. Its health benefits range from reduction of all-cause mortality [1] to improvement of cognitive function [2]. While cycling has significant benefits to health and fitness, the constant pressure exerted by the bicycle seat might be the cause of several complaints, ranging from saddle sores to more serious complaints related to the urogenital system. Schrader et al. [3] examined the effect of riding a bicycle on nocturnal penile tumescence. They have reported a significant, inverse correlation between the pressure exerted on the nose of the bicycle seat and the percentage of sleeping time with an erection. A survey of 2774 cyclists and 1158 non-cyclists revealed that cycling is associated with a significantly higher risk of experiencing perineal numbness and developing urethral stricture [4]. Up to 91% of bicycle users experience perineal numbness [5]. Cyclists complaining of perineal numbness are more likely to report erectile dysfunction (ED) [6, 7]. The link between cycling and ED is still a matter of discussion. A recent meta-analysis by Gao et al. found a positive correlation between ED and cycling when controlling for age (odds ratio [OR] 1.55). However, included studies presented significant heterogeneity [8].
Commonly genital numbness is attributed to Alcock’s syndrome, a condition first described in two cyclists, who suffered from genital hypesthesia lasting over 4 weeks [9]. Vascular occlusion and subsequent hypoxemia of the
pudendal nerve may also play a role. Both of these mechanisms can stem from an increase of perineal pressure caused by sitting on the bicycle seat [10]. Nanka et al. proposed that the most important site of compression could be the sulcus nervi dorsalis penis, which courses near the pubic symphysis [11]. This hypothesis is supported by three-dimensional models of the perineum, which point to the area in proximity of pubic symphysis as the most susceptible to the increase in seat pressure [12–14]. This leads to the conclusion that the reduction of anterior seat pressure may be the most important factor in reducing the incidence of perineal numbness.
Currently, very little evidence-based advice can be offered for patients complaining of cycling-induced perineal numbness and other conditions associated with high seat pressure. The possible link between perineal numbness and ED highlights the importance of perineal protection. With this in mind, the goal we have set for this systematic review is to present currently available options for mitigating the negative effects of cycling on the perineum, examining how strong the evidence supporting a given strategy is, and assessing the size of its effects in healthy males. Additionally, we have reviewed how various strategies impact the comfort of the user and other regions in contact with the seat.
5 Conclusions
Current evidence supports the use of no-nose saddles as a means to reduce the negative impact of cycling on penile oxygen pressure. Standing on the pedals every ten minutes might be an effective and potentially widely applicable strategy. The use of a recumbent bike appears to protect the perineum, but several concerns prevent their widespread use.
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Introduction Perineal pressure associated with bicycle riding is the cause of several genitourinary pathologies, most notably Alcock’s syndrome, and subsequent perineal numbness. The possible link between cycling-induced perineal numbness and erectile dysfunction makes the development of strategies for perineal protection in bicycle users critical.
Objective To assess the effectiveness of strategies for reducing the impact of cycling on the perineum in healthy males. Methods We have conducted a systematic review and a meta-analysis of studies examining various means of reducing the impact of cycling on the perineum under the PRISMA guidelines.
Results Out of 2217 screened studies, 22 met our inclusion criteria and 6 qualified for meta-analysis. The strategies included various designs of saddles, changes in the cycling position, seat shock absorber, shorts with different padding, using the recumbent bike. Using the no-nose saddle and recumbent bike resulted in a significant reduction of perineal pressure and higher penile oxygen pressure compared with a standard saddle. Indirect evidence supports the protective effect of standing on the pedals every few minutes during cycling. More evidence is needed to support—or dismiss—other strategies.
Conclusions Current evidence supports the use of no-nose saddles as a means to reduce the negative impact of cycling on the perineum in healthy males at the cost of worse stability and an increase of posterior seat pressure. Standing on the pedals every ten minutes might be an effective and potentially widely applicable strategy. The use of a recumbent bike appears to protect the perineum, but several concerns prevent its widespread use.
1 Introduction
Cycling is one of the most commonly used cardiovascular exercises. Its health benefits range from reduction of all-cause mortality [1] to improvement of cognitive function [2]. While cycling has significant benefits to health and fitness, the constant pressure exerted by the bicycle seat might be the cause of several complaints, ranging from saddle sores to more serious complaints related to the urogenital system. Schrader et al. [3] examined the effect of riding a bicycle on nocturnal penile tumescence. They have reported a significant, inverse correlation between the pressure exerted on the nose of the bicycle seat and the percentage of sleeping time with an erection. A survey of 2774 cyclists and 1158 non-cyclists revealed that cycling is associated with a significantly higher risk of experiencing perineal numbness and developing urethral stricture [4]. Up to 91% of bicycle users experience perineal numbness [5]. Cyclists complaining of perineal numbness are more likely to report erectile dysfunction (ED) [6, 7]. The link between cycling and ED is still a matter of discussion. A recent meta-analysis by Gao et al. found a positive correlation between ED and cycling when controlling for age (odds ratio [OR] 1.55). However, included studies presented significant heterogeneity [8].
Commonly genital numbness is attributed to Alcock’s syndrome, a condition first described in two cyclists, who suffered from genital hypesthesia lasting over 4 weeks [9]. Vascular occlusion and subsequent hypoxemia of the
pudendal nerve may also play a role. Both of these mechanisms can stem from an increase of perineal pressure caused by sitting on the bicycle seat [10]. Nanka et al. proposed that the most important site of compression could be the sulcus nervi dorsalis penis, which courses near the pubic symphysis [11]. This hypothesis is supported by three-dimensional models of the perineum, which point to the area in proximity of pubic symphysis as the most susceptible to the increase in seat pressure [12–14]. This leads to the conclusion that the reduction of anterior seat pressure may be the most important factor in reducing the incidence of perineal numbness.
Currently, very little evidence-based advice can be offered for patients complaining of cycling-induced perineal numbness and other conditions associated with high seat pressure. The possible link between perineal numbness and ED highlights the importance of perineal protection. With this in mind, the goal we have set for this systematic review is to present currently available options for mitigating the negative effects of cycling on the perineum, examining how strong the evidence supporting a given strategy is, and assessing the size of its effects in healthy males. Additionally, we have reviewed how various strategies impact the comfort of the user and other regions in contact with the seat.
5 Conclusions
Current evidence supports the use of no-nose saddles as a means to reduce the negative impact of cycling on penile oxygen pressure. Standing on the pedals every ten minutes might be an effective and potentially widely applicable strategy. The use of a recumbent bike appears to protect the perineum, but several concerns prevent their widespread use.
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