Effect of Oscillation on Perineal Pressure in Cyclists: Implications for Micro-Trauma

Sanford, Thomas; Gadzinski, Adam J.; Gaither, Thomas W.; Osterberg, E. Charles; Murphy, Greg P.; Carroll, Peter R.; Breyer, Benjamin N.

doi:10.1016/j.esxm.2018.05.002

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…19 Afferent sensory stimuli from peripheral nerves are conveyed to the spinal cord via the pudendal nerve which is most vulnerable to cyclingrelated microtrauma. 20,21 Our study is not without limitations. FSD is a complex diagnosis that encompasses but is not limited to desire, arousal, orgasm, and sexual-related pain.…”

Section: Discussionmentioning

confidence: 92%

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Association of Bicycle-Related Genital Numbness and Female Sexual Dysfunction: Results From a Large, Multinational, Cross-Sectional Study

et al. 2021

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Introduction: Cycling can lead to microtrauma due to increased perineal pressure, possibly contributing to genital numbness and sexual dysfunction in female cyclists. Aim: We aim to explore the associations between cycling characteristics, female genital numbness, and female sexual dysfunction. Methods: We conducted a cross-sectional study on female cyclists and sexual wellness. Participants were recruited through Facebook Ò advertisements and online outreach at athletic clubs. Participants were asked about their cycling characteristics, genital numbness, and female sexual function using the Female Sexual Function Index (FSFI). Univariate and multivariable linear and logistic regression were used to assess risk factors for genital numbness and the association between genital numbness and the FSFI. Outcome Measures: The outcome measures were cycling characteristics, questions regarding numbness (intensity, duration, location), and the FSFI score. Results: Eight-hundred and seventy-five women were included in the study. Total lifetime miles cycled, biking duration, frequency, distance, speed, and biking surface were not significantly associated with genital numbness. Higher handlebar height was associated with less numbness. The prevalence of sexual dysfunction in the cohort was 52%. Genital numbness was significantly associated with sexual dysfunction (OR: 1.43, 95% CI: 1.05 − 1.95). Sub-group analysis for location of numbness demonstrated significant increase in risk for sexual dysfunction in cyclists who described numbness aro`und the perineum (OR: 2.72, 95% CI: 1.05 − 7.02) and the vulva (OR: 1.55, 95% CI: 1.13 − 2.13). There was also a significant increase in the risk of sexual dysfunction in cyclists who reported a longer duration of numbness (OR: 6.58, 95% CI: 2.27 − 19.07). Conclusions: Genital numbness is common in women who cycle and is associated with increased risk of FSD and lower average sexual response scores on FSFI.

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Section: Discussionmentioning

confidence: 92%

“… 19 Afferent sensory stimuli from peripheral nerves are conveyed to the spinal cord via the pudendal nerve which is most vulnerable to cycling-related microtrauma. 20 , 21 …”

Section: Discussionmentioning

confidence: 99%

Association of Bicycle-Related Genital Numbness and Female Sexual Dysfunction: Results From a Large, Multinational, Cross-Sectional Study

et al. 2021

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“…Sanford et al [ 38 ] evaluated the effect of a seat shock absorber on perineal pressure in various conditions—pedaling or stationary, with and without artificial oscillations. A shock absorber significantly reduced pressure in the anterior and posterior perineum in stationary conditions with oscillations but not while pedaling with oscillations.…”

Section: Resultsmentioning

confidence: 99%

“…This approach omits several important conditions associated with cycling in the field setting. The notable examples include different terrain, oscillations, and varying workloads, which could affect the perineal pressure and comfort of the bicycle user [ 38 , 41 ]. Additionally, most of the included studies consisted of just a few, relatively short sessions.…”

Section: Discussionmentioning

confidence: 99%

Strategies for Reducing the Impact of Cycling on the Perineum in Healthy Males: Systematic Review and Meta-analysis

2020

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Introduction Perineal pressure associated with bicycle riding is the cause of several genitourinary pathologies, most notably Alcock’s syndrome and subsequent perineal numbness. The possible link between cycling-induced perineal numbness and erectile dysfunction makes the development of strategies for perineal protection in bicycle users critical. Objective To assess the effectiveness of strategies for reducing the impact of cycling on the perineum in healthy males. Methods We have conducted a systematic review and a meta-analysis of studies examining various means of reducing the impact of cycling on the perineum under the PRISMA guidelines. Results Out of 2217 screened studies, 22 met our inclusion criteria, and 6 qualified for meta-analysis. The strategies included various designs of saddles, changes in the cycling position, seat shock absorber, shorts with different padding, using the recumbent bike. Using the no-nose saddle and recumbent bike resulted in a significant reduction of perineal pressure and higher penile oxygen pressure compared with a standard saddle. Indirect evidence supports the protective effect of standing on the pedals every few minutes during cycling. More evidence is needed to support—or dismiss—other strategies. Conclusions Current evidence supports the use of no-nose saddles as a mean to reduce the negative impact of cycling on the perineum in healthy males at the cost of worse stability and increase of posterior seat pressure. Standing on the pedals every ten minutes might be an effective and potentially widely applicable strategy. The use of a recumbent bike appears to protect the perineum, but several concerns prevent its widespread use.

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“…19 Sanford et al incorporated seat post shock absorbers into traditional saddles and established that this modification can alleviate microtrauma to genital structures. 20 Despite increasing research to improve bicycle design, few studies have characterized saddle preferences, associated symptoms, and cycling habits among the broader cycling community. It is critical to understand adoption trends among cyclists given that cycling for both active travel and aerobic exercise confers numerous health benefits.…”

Section: Introductionmentioning

confidence: 99%

The Association Between Pelvic Discomfort and Erectile Dysfunction in Adult Male Bicyclists

Balasubramanian

Breyer

et al. 2020

The Journal of Sexual Medicine

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Background: Bicycle riding's impact on erectile function remains a topic of great interest given cycling's popularity as a mode of transportation and exercise. Aim: We evaluated risk factors for sexual dysfunction in male cyclists with the primary intention of determining if genital/pelvic pain and numbness are associated with erectile dysfunction (ED). Methods: We surveyed male cyclists using an online anonymous questionnaire. Cyclists were queried on their demographics, cycling experience, and sexual function using the Sexual Health Inventory for Men (SHIM). ED was diagnosed when a completed SHIM score was <22. Regression analysis was used to evaluate the risk of ED in men with genital/pelvic pain or numbness after riding. The survey was designed in the United States. Outcomes: Quantitative characterization of cycling habits, onset and timing of genital pain and numbness, and SHIM score. Results: A total of 1635 participants completed the survey. A majority of men were over the age of 50 (58%, 934/1,607), Caucasian (88%, 1,437/1,635), had been active cyclists for over 10 years (63%, 1,025/1,635) and used road bikes (97%, 1,578/1,635). Overall, 22%, 30%, and 57% of men reported ED, genital pain, and genital numbness, respectively. While controlling for cohort demographics, body mass index, cycling intensity and equipment, and medical comorbidities, no saddle characteristics were associated with the risk of developing genital numbness. However, men reporting penile numbness were at higher risk of reporting ED (odds ratio [OR] ¼ 1.453, P ¼ .048). In addition, quicker onset of numbness and resolution of numbness within a day was associated with impaired erectile function. For example, numbness occurring less than 1 hour after cycling had greater odds of leading to ED than numbness after 5 hours (OR ¼ 2.002, P ¼ .032). Similarly, genital pain occurring less than 1 hour (OR ¼ 2.466, P ¼ .031) after cycling was associated with higher ED risk. Strengths & Limitations: Strengths include a large sample size of high-intensity cyclists and validated questionnaire use. Limitations include reliance on anonymous self-reported survey data and minimal inquiry into the riding preferences and terrain traversed by cyclists. Conclusions: Pelvic pain and numbness are common complaints among male riders in the United States. Men with such complaints are more likely to also report ED especially if it occurs earlier in the ride. Although direction of causality and temporality are uncertain, alleviation of factors resulting in pelvic discomfort may reduce cycling's impact on sexual function. Such interventions are critical given that cycling for both active travel and aerobic exercise confers numerous health benefits.

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Effect of Oscillation on Perineal Pressure in Cyclists: Implications for Micro-Trauma

Cited by 11 publications

References 20 publications

Association of Bicycle-Related Genital Numbness and Female Sexual Dysfunction: Results From a Large, Multinational, Cross-Sectional Study

Association of Bicycle-Related Genital Numbness and Female Sexual Dysfunction: Results From a Large, Multinational, Cross-Sectional Study

Strategies for Reducing the Impact of Cycling on the Perineum in Healthy Males: Systematic Review and Meta-analysis

The Association Between Pelvic Discomfort and Erectile Dysfunction in Adult Male Bicyclists

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