|
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)
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.
|