Huang V et al. (2005) Bicycle riding and erectile dysfunction: an increase in interest (and concern). J Sex Med 2: 596–604

When investigating patients with erectile dysfunction (ED), Huang and colleagues observed a high incidence of blunt perineal trauma, often associated with cycling. Concern regarding this association has grown over the past two decades, prompting the team to summarize the data published on the subject and to suggest measures that cyclists could use to minimize the risk of ED. The authors looked at case reports, observational series, case-control studies, mechanistic investigations, and population-based epidemiologic studies.

The literature revealed that the rider's interaction with the saddle seems to be related to the development of ED: straddling the saddle leads to perineal compressive pressures and occludes penile blood flow. Acute trauma—falling on the crossbar, for example—can also contribute to the development of ED.

Based on their findings, the authors recommend that cyclists opt for wider saddles without protruding front extensions, which have been shown to reduce penile blood flow, and tilt the front of the saddle downwards to reduce perineal pressure. Gel saddles have been shown to promote better penile oxygenation than foam saddles, as has adopting a more upright or reclining position. Better still, cyclists could replace traditional bicycles with recumbent bicycles, which are not associated with ED.

The authors note that perineal compression time can be reduced by cycling less often or standing up on the pedals, but discourage giving up cycling altogether owing to its cardiovascular benefits, which actually protect against ED, as well as the benefits to the environment.