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New York Times / October 4, 2005 Serious Riders, Your Bicycle Seat May Affect Your Love Life By SANDRA BLAKESLEE A raft of new studies suggest that cyclists, particularly men, should be careful which bicycle seats they choose. The studies add to earlier evidence that traditional bicycle seats, the kind with a narrow rear and pointy nose, play a role in sexual impotence. Some bicycle seat designs are more damaging than others, scientists say. But even so-called ergonomic bicycle seats, to protect the sex organs, can be harmful, the research finds. The dozen or so studies, from peer-reviewed journals, are summarized in three articles in September's Journal of Sexual Medicine. In a bluntly worded editorial with the articles, Dr. Steven Schrader, a reproductive health expert who studies cycling at the National Institute for Occupational Safety and Health, said he believed that it was no longer a question of "whether or not bicycle riding on a saddle causes erectile dysfunction." Instead, he said in an interview, "The question is, What are we going to do about it?" The studies, by researchers at Boston University and in Italy, found that the more a person rides, the greater the risk of impotence or loss of libido. And researchers in Austria have found that many mountain bikers experience bicycle seat-related trauma that leads to small calcified masses inside the scrotum. This does not mean that people should stop cycling, Dr. Schrader said. And those who ride bikes rarely or for short periods need not worry. But riders who spend many hours on a bike each week should be concerned, he said. And he suggested that the bicycle industry design safer bicycle seats and stop trivializing the risks of the existing bicycle seats. A spokesman for the industry said it was aware of the issue and added that "new designs are coming out." "Most people are not riding long enough to damage themselves permanently," said the spokesman, Marc Sani, publisher of Bicycle Retailer and Industry News. "But a consumer's first line of defense, for their enthusiasm as well as sexual prowess, is to go to a bicycle retailer and get fitted properly on the bike." Researchers have estimated that 5 percent of men who ride bikes intensively have developed severe to moderate erectile dysfunction as a result. But some experts believe that the numbers may be much higher because many men are too embarrassed to talk about it or fail to associate cycling with their problems in the bedroom. The link between bicycle seats and impotence first received public attention in 1997 when a Boston urologist, Dr. Irwin Goldstein, who had studied the problem, asserted that "there are only two kinds of male cyclists ’Äì those who are impotent and those who will be impotent." Cyclists became angry and defensive, he said, adding: "They said cycling is healthy and could not possibly hurt you. Sure you can get numb. But impotent? No way." The bicycle industry listened, said Joshua Cohen, a physical therapist in Chapel Hill, N.C., and the author of "Finding the Perfect Bicycle Seat." Manufacturers designed dozens of new saddles with cut outs, splits in the back and thick gel padding to relieve pressure on tender body parts. Scientists also stepped up their research. Since 2000, a dozen studies have been carried out using sophisticated tools to see exactly what happens when vulnerable human anatomy meets the bicycle seat. The area in question is the perineum, between the external genitals and the anus. "When you sit on a chair you never put weight on the perineum," Dr. Schrader said. "But when you sit on a bike, you increase pressure on the perineum" sevenfold. In men, a sheath in the perineum, called Alcock's canal, contains an artery and a nerve that supply the penis with blood and sensation. The canal runs along the side of a bone, Dr. Goldstein said, and when a cyclist sits hard on a narrow saddle, the artery and the nerve are compressed. Over time, a reduction of blood flow can mean that there is not enough pressure to achieve full erection. In women, Dr. Goldstein said, the same arteries and nerves engorge the clitoris during sexual intercourse. Women cyclists have not been studied as much, he added, but they probably suffer the same injuries. Researchers are using a variety of methods to study the compression caused by different bicycle seats. One method involves draping a special pad with 900 pressure sensors over the saddle. The distribution of the rider's weight is then registered on a computer. In another technique, sensors are placed on the rider's penis to measure oxygen flowing through arteries beneath the skin. Blood flow is detected by other sensors that send a "swoosh" sound to a Doppler machine. The research shows that when riders sit on a classic bicycle seat with a teardrop shape and a long nose, a quarter of their body weight rests on the nose, putting pressure on the perineum. The amount of oxygen reaching the penis typically falls 70 percent to 80 percent in three minutes. "A guy can sit on a bicycle seat and have his penis oxygen levels drop 100 percent but he doesn't know it," Mr. Cohen said. "After half an hour he goes numb." Dr. Goldstein added, "Numbness is your body telling you something is wrong." Today's ergonomic bicycle seats have splits in the back or holes in the center to relieve pressure on the perineum. But this may make matters worse: the ergonomic bicycle seats have smaller surface areas, so the rider's weight presses harder on less seat, Dr. Schrader said. The perineum may not escape injury because its arteries run laterally and they are not directly over the cutouts. The arteries can come under more pressure when they come into contact with the cutouts' edges. Thick gels on bicycle seats can also increase pressure to the perineum, the studies found, because the material can migrate and form clumps in all the wrong places. Just as many smokers do not get lung cancer, many cyclists will never develop impotence from bicycle seats, the scientists said. What makes one person more vulnerable than another is not known. Body weight seems to matter: heavier riders exert more pressure on saddles. Variations in anatomy may also make a difference. Dr. Goldstein said he often saw patients who were stunned to learn that riding a bicycle led to their impotence. One middle-aged man rode in a special cycling event to honor a friend and has been impotent since. A 28-year-old who came in for testing, Dr Goldstein said, showed the penile blood flow of a 60-year-old. A college student who had competed in rough cycling sports was unable to achieve an erection until microvascular surgery restored penile blood flow. "We make kids wear helmets and knee pads," Dr. Goldstein said. "But no one thinks about protecting the crotch." The safest bicycle seats, experts say, force the rider to sit back firmly on the sit bones so the perineum is protected. Dr. Schrader advocates bicycle seats that do not have noses. After finding that traditional bicycle seats reduce the quality of nighttime erections in young policemen who patrol on bicycles, he has persuaded scores of officers in several cities to use noseless seats and is now studying the officers' sexual function over six months. ------------------------------------- J Sports Med Phys Fitness. 2005 Sep;45(3):409-18: Effect of bike seat design on transcutaneous penile oxygen pressure. Cohen JD, Gross MT. Program in Human Movement Science, Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, NC 27517, USA. AIM: To determine the reliability of monitoring penile transcutaneous oxygen (tpO2) during cycling, and to assess the influence of Bike Seat design and cycling position on tpO2. METHODS: Experimental design: repeated measures analysis of the effects of seat design and riding position on tpO2 values. Participants: 31 male cyclists between the ages of 20 and 50 years participated. Subject inclusion criteria were: averaged approx. 80 miles of road bicycling per week during the 2 months prior to enrollment in this study; no history of vascular disease, diabetes, or sexual dysfunction; and had an erection within 15 days prior to study. MEASURES: mean tpO2 values were calculated for seated and standing positions using 3 current bike seat designs. RESULTS: Seat design had no significant effect on tpO2 values. Seated cycling significantly reduced tpO2 levels compared with standing cycling. Mean percent decreases in tpO2 from standing to seated cycling were; Vetta 76%, Terry 73%, and Specialized 62%. CONCLUSION: None of the bike seats exhibited any significant ability to spare penile tpO2. ------------------------------------- Three new articles published in the current issue of The Journal of Sexual Medicine concluded that the high pressures in the perineum while straddling a bike seat compress and temporarily occlude penile blood flow. The three articles are: - "Bike Riding and Erectile Dysfunction: An Increase in Interest (and Concern)" by Huang et al - "Only the Nose Knows: Penile Hemodynamic Study of the Perineum - Saddle Interface in Men with Erectile Dysfunction Utilizing Bike Saddles and Seats with and without Nose Extensions" by Munarriz et al - "Development of a New Geometric Bike Saddle for the Maintenance of Genital-Perineal Vascular Perfusion" by Breda et al Dr. Schrader, a research biologist at the National Institute for Occupational Safety and Health (NIOSH) advocates bike seats that do not have noses. His 2002 research reported on the hazards of bike riding in police officers and concluded that traditional bike seats reduced the quality of nighttime erections in young policemen who patrol on bikes. Nighttime erection quality decreased as seat pressure increased and as the average number of hours in the saddle a day increased. Dr. Schrader states: "The next steps are quite clear. Effective strategies based on sound ergonometrics and urogenital physiologic principles and testing are needed to reduce the risk of erectile dysfunction from bike riding." Schrader further concluded that "the health benefits from having unrestricted vascular flow to and from the penis are self-evident." Nunzio Lamaestra, a 46-year-old police officer in San Antonio, said he appreciated his noseless bike saddle. "You get used to riding without the nose," he said. "I can do everything, including ride with no hands." Biking may be Hazardous to Your Health - Charles Downey Doctors say that sitting on a bike seat can crush vital arteries and nerves leading to the penis. What should you do if you're an avid cyclist?  A 54-year-old Boston attorney figured he was in great shape because, weather permitting, he rode his bike at least one hundred miles a week. During inclement weather, he pedaled on a stationary bike. But during a 200-mile, two-day charity event, the lawyer noticed his penis was numb, and that's not the worst of it. For about the next month, he had trouble getting, and keeping, an erection. Puzzled, he made an appointment to see Irwin Goldstein, MD, professor of urology at Boston University School of Medicine. Dr. Goldstein, who sees about six avid cyclists a week suffering from erectile dysfunction (ED), quickly suspected the problem was caused by sitting too long on a narrow, hard bike seat. And when an avid cyclist leans forward on his arms in the "aero" position, he puts even more pressure on a delicate part of his anatomy. The human rear is perfectly designed to support the weight of the body on two "sit bones." Those structures are protected by muscle and fat and have no arteries or nerves that could be crushed by your weight. As long as you are sitting on a flat surface, like a chair or couch, your sit bones easily support your weight. It's a different story when you sit for long periods on a narrow bike seat. "The penis is part of a hydraulic system," says Dr. Goldstein. "When stimulated, its twin chambers fill with blood until it's erect. After ejaculation, the blood leaves and the penis softens again." But about half that hydraulic system is inside the body. When a man sits on a narrow bike seat, his body weight can crush the pudendal artery and nerves that serve the penis. That sensitive area between the anus and the scrotum is known as the perineum. So bike riding can result in temporary and permanent impotence. Extra padding or jell padding in the seat does not help because the padding bunches up and also cuts off circulation. "I tell my biking patients they take their sex lives in their hands when they ride bikes," says Dr. Goldstein. Dr. Goldstein and his colleagues at Duke University in Durham, North Carolina and Case Western Reserve University in Cleveland studied 81 avid bike riders who were suffering from ED. The team presented their findings in the December 1999 issue of the Journal of Urology. The researchers found that nerves, arteries, and veins in the perineum can indeed be damaged by bike seats. Yet another test group of 100 men with ED revealed that it takes only about 11% of a man's body weight to compress the vital artery. Similar results were also seen in a 2001 study published in the International Journal of Sports Medicine. Overall, Dr. Goldstein estimates there are about 100,000 impotence-cursed men whose woes started with bicycling. He says that overweight riders and cyclists who peddle many miles weekly are at higher risk for impaired erection. In women, Dr. Goldstein said, the same arteries and nerves engorge the clitoris during sexual intercourse. Women cyclists have not been studied as much, he added, but they probably suffer the same injuries The research shows that when riders sit on a classic bike seat with a teardrop shape and a long nose, a quarter of their body weight rests on the nose, putting pressure on the perineum. The amount of oxygen reaching the penis typically falls 70 percent to 80 percent in three minutes. "A guy can sit on a bike seat and have his penis oxygen levels drop 100 percent but he doesn't know it," Mr. Cohen said. "After half an hour he goes numb." Dr. Goldstein added, "Numbness is your body telling you something is wrong." Today's ergonomic saddles have splits in the back or holes in the center to relieve pressure on the perineum. But this may make matters worse: the ergonomic saddles have smaller surface areas, so the rider's weight presses harder on less saddle, Dr. Schrader said. The perineum may not escape injury because its arteries run laterally and they are not directly over the cutouts. The arteries can come under more pressure when they come into contact with the cutouts' edges. Thick gels on saddles can also increase pressure to the perineum, the studies found, because the material can migrate and form clumps in all the wrong places.

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