title: Bicycle riding and erectile dysfunction: an increase in interest (and concern).
abstract: BACKGROUND
  From 1999 to 2004, there had been 21 publications from multiple medical specialties (sexual medicine, urology, neurology, cardiology, biomedical engineering, sports medicine, emergency medicine, and officials from the National Institute for Safety and Occupational Health) investigating the relationship between bicycle riding and erectile dysfunction (ED). In the previous 18 years, there have been 14 such studies.
  
  
  OBJECTIVE
  The primary aim was to summarize accumulating data on the safety of bicycle riding based on medical evidence categorized by levels of evidence, including case reports, observational studies, case control studies, mechanistic studies, and population-based epidemiologic investigations. The secondary aim was to address the concerns of bicyclists and propose measures to minimize the risk of ED associated with bicycle riding.
  
  
  METHODS
  An English-language medical literature review was made of publications in peer review journals from 1981 to 2004, including published abstract presentations at major medical meetings.
  
  
  METHODS
  Ranked published epidemiologic data on bicycle riding and ED.
  
  
  RESULTS
  Bicycle riding more than 3 hours per week was an independent relative risk (RR = 1.72) for moderate to severe ED. In case control studies, the prevalence of moderate to severe ED in bicyclists was 4.2% and 4% vs. age-matched runners 1.1% (P < or = 0.018) and swimmers 2% (P = 0.05), respectively. Therefore, bicycle riders should take precautionary measures to minimize the risk of ED associated with bicycle riding: change the bicycle saddle with a protruding nose to a noseless seat, change the posture to a more upright/reclining position, change the material of the saddle (GEL), and tilt the saddle/seat downwards.
  
  
  CONCLUSIONS
  The mechanism is hypothetically related to the rider interaction with the bicycle saddle at the perineum-saddle interface. Straddling bicycle saddles with a nose extension is associated with suprasystolic perineal compression pressures, temporarily occluding penile perfusion and potentially inducing endothelial injury and vasculogenic ED.
authors.affiliation: Institute for Sexual Medicine, Department of Urology, Boston University School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Huang
authors.forename: Ricardo
authors.initials: R
authors.lastname: Munarriz
authors.forename: Irwin
authors.initials: I
authors.lastname: Goldstein
mesh_terms: D001291:Attitude of Health Personnel; D001642:Bicycling; D007172:Erectile Dysfunction / Q000209:etiology* / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D010413:Penis / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology; D010525:Peripheral Nerves / Q000503:physiopathology