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Journal of Andrology, Vol. 23, No. 6, November/December 2002
Copyright © American Society of Andrology

Perspectives and Editorials

Editorial Commentary

Irwin Goldstein, MD, Director
Institute for Social Medicine
Boston University School of Medicine
Boston, Massachusetts

Schrader SM, Breitenstein MJ, Clark JC, Lowe BD, Turner TW. Nocturnal penile tumescence and rigidity testing of bicycle patrol officers. J Androl.2002 ;23:927–934.[Abstract/Free Full Text]


Bicycle riding is a public health paradox (Andersen and Bovim, 1997; Ricchuti et al, 1999; Marceau et al, 2001; Sommer et al, 2001a,b). On the one hand, bicycle riding is a popular form of transportation, encouraged by physicians for positive cardiovascular benefits and used for recreation, adventure, relaxation, aerobic exercise, and weight loss. On the other hand, bicycle riding is a physical activity associated with significant compression of perineal contents, leading in some men and women to permanent and irreversible sexual dysfunction. A recent population study (Marceau et al, 2001) found the age and cardiovascular risk-adjusted relative risk of erectile dysfunction in men aged 40-70 who rode bicycles for 3 or more hours per week was 1.72. With particular attention to sexual dysfunction, bicycle riders tend to be younger, healthier, and more athletic than traditional patients with sexual impairment, and the implications and psychologic impact of their sexual dysfunction may be more profound.

Schrader et al (2002) bring a new, fresh "occupational" perspective to the dilemma of bicycle-riding—associated sexual dysfunction. The National Institute for Occupational Safety and Health (NIOSH) is the federal agency entrusted with occupational health assessments. This novel research paper investigates the sexual health consequences of members of a bicycling police unit, a classic example of individuals who spend a majority of their day straddling bicycle saddles and then complain of perineal numbness. As an aside, we have seen numerous bicycle-riding policemen as patients with sexual dysfunction and have observed, in some, restoration of erectile capabilities following microvascular arterial bypass surgery. One critical, resourceful, and innovative contribution from Schrader et al (2002) is the measurement of the pressure of the cyclist's perineum on the bicycle saddle. This ingenious determination was made using a thin profile, resistance-based pressure measurement mat with sensors having a spatial resolution of 1.6 cm2. Figure 1 in Schrader et al (2002) illustrates the ultimate predicament of bicycle riding. The perineal pressure distribution while sitting on a chair is borne by the ischial tuberosities; the perineal pressure distribution while straddling a bicycle saddle (upright or pursuit position) is borne by the perineal contents, including the common penile artery, pudendal nerve, and penile crurae. Schrader et al (2002) documented an occupational sexual health consequence in bicycle-riding policemen. During sleep, bicyclists had significantly fewer erection events than nonbicyclists.

On the basis of published literature and clinical experience, if bicycle saddles were "chemical substances" rather than "mechanical devices," it is likely that there would be established standards of safety exposure. Examples of such safety exposure include a NIOSH criteria document, a federal government—established Permissible Exposure Level (PEL), and an American Council of Government Industrial Hygienist (ACGIH)—established time-weighted average—threshold limit value. More likely than not, there would also exist a state and municipal ban on occupations (bicycle-riding policemen, couriers, etc) using traditional narrow bicycle saddles.

This paper represents another milestone in the effort to document the sexual health hazards of bicycle riding, and there is strong agreement about the need for innovative bicycle saddle design.


References

Andersen KV, Bovim G. Impotence and nerve entrapment in long distance amateur cyclists. Acta Neurol Scand.1997; 95:233 -240.[Medline]

Marceau L, Kleinman K, Goldstein I, McKinlay J. Does bicycling contribute to the risk of erectile dysfunction? Results from the Massachusetts Male Aging Study (MMAS). Int J Impot Res.2001; 13:298 -302.[Medline]

Ricchuti VS, Haas CA, Seftel AD, Chelimsky T, Goldstein I. Pudendal nerve injury associated with avid bicycling. J Urol.1999; 162:2099 -2100.[Medline]

Sommer F, Konig D, Graft C, Schwarzer U, Bertram C, Klotz T, Engelmann U. Impotence and genital numbness in cyclists. Int J Sports Med. 2001a;22:410 -413.[Medline]

Sommer F, Schwarzer U, Klotz T, Caspers HP, Haupt G, Engelmann U. Erectile dysfunction in cyclists. Is there any difference in penile blood flow during cycling in an upright versus a reclining position? Eur Urol. 2001b;39:720 -723.[Medline]





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