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

Abstract

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.

Could Proprioceptive Stimuli Change Saddle Pressure on Male Cyclists during Different Hand Positions? An Exploratory Study of the Effect of the Equistasi® Device

“…Cycling has been recognized as an important means of promoting public health and it is among the most popular sports [1][2][3]. However, the constant pressure exerted on the bicycle seat might be the cause of non-traumatic injuries [4], ranging from saddle sores to more serious disorders related to the urogenital system [5].…”

Saddle Pressures Factors in Road and Off-Road Cyclists of Both Genders: A Narrative Review

“…In fact, the study by Sommer et al (2001) [10] confirmed that pedaling in an upright position does not cause any alteration of the penile blood supply. As a matter of fact, the constant pressure exerted on the bicycle saddle could be the cause of non-traumatic injuries [11], ranging from saddle sores to more serious disorders related to the urogenital system [12].…”

“…In the last decade, the measurement of pressures in the saddle and the related compression on the perineum has been investigated [ 14 ]. A survey of 2,774 cyclists and 1,158 non-cyclists revealed that cycling is associated with a significantly higher risk of perineal numbness and urethral stricture development [ 12 ]. Up to 91% of cyclists experienced perineal numbness.…”