Andrew Siegel, MD 5/2/15
(Nude cyclist 1995 Fremont Solstice Parade…thank you Wikipedia Commons)
When sitting on a saddle—whether a bike seat, motorcycle seat, horse, etc.—one places a great deal of body weight on the perineum (area between genitals and anus), putting anatomy that is usually protected into a vulnerable position. Prolonged time in the saddle can compress vital genital nerves and arteries and traumatize the pelvic floor muscles (PFMs) that are essential for erectile and clitoral rigidity. The scrotum and the inner aspect of the penis (penile roots anchored to the pelvic bones) as well as the labia and inner aspect of the clitoris can be compressed as well. Over time, with repeated stress to the pudendal nerve and artery, PFMs and penile root, damage may lead to sexual dysfunction.
Cycling, in particular, has the potential for wreaking pelvic havoc. The downward force of the cyclist’s weight while tilting forward on the saddle generates extreme pressure on the perineum that pinches the pudendal nerve and artery against the pubic arch. Both the duration and the magnitude of compression are factors in determining the degree of trauma. Moreover, many cyclists are lean and their limited body fat does not provide padding that could potentially offer some relief from saddle pressure. Cycling-related sexual dysfunction has multiple factors involved including the geometry and hardness of the saddle, the anatomical variations of the individual, the amount of time spent in the saddle, the cyclist’s weight, the intensity of the effort, and the style of sitting, which is nuanced and variable.
Wide Enough, Flat Enough, Firm Enough
The saddle nose is the part of the bike seat that is especially dangerous. Greater saddle width and the absence of a saddle nose have been the most important factors in preventing compression. If the saddle is not wide enough to support the ischial tuberosities (sit bones), body weight is borne by the perineum. It is important for a saddle to be flat enough because if there is too much curvature, the center of the saddle can push up into the perineum and cause compression. Additionally, it is important that a saddle is firm enough. Gel saddles actually cause more trauma than unpadded saddles by virtue of the body sinking into the soft padding. The reduced surface area of saddles with a narrow cutout can actually increase the extent of the pressure (on the edges of the cutout); however, for those cyclists who find that if they have a saddle that is sufficiently wide, flat and firm yet remains uncomfortable, they may need a cutout to help relieve some of the discomfort.
Numerous factors influence compression. A horizontal or downward-pointing saddle position causes less pressure. Heavier riders exert more pressure on their saddles than lighter riders. Lower handlebars may worsen the situation by forcing the rider to lean forward, putting more body weight on the perineum. As a cyclist goes from sitting upright to the bent over aerodynamic position, the torso and pelvis rotate forward and the sit bones are lifted off the saddle surface, shifting more weight onto the perineum. This is clearly a superior position for racing, but inferior for one’s genital health! On the other extreme, when standing on the pedals, there is no pressure. Mountain bikes cause a greater degree of sexual dysfunction than road bikes, likely because of the additional hammering and vibrational trauma from cycling over rough terrain; however, this is balanced to some extent by the use of suspension mechanisms, the increased time spent out of the saddle and more frequent dismounts.
Kegels For Your Pelvic Health: Resuscitate Your Genitals
Dr. Arnold Kegel popularized PFM exercises to improve female sexual and urinary health after childbirth. His legacy lives on with the exercises that bear his name—Kegel exercises. Men have the same PFM as do women and an equivalent capacity for exercising them, with parallel benefits to urinary and sexual health. Saddle sport participants can tap into their PFMs to pump some “life” back into their compromised genitals after a long ride.
Similar to using a bike pump to inflate tires so that they are well pressurized, with each contraction of the PFM, blood pumps into the genital tissues to help “resuscitate” them.
PFM training can be valuable to help lessen pelvic trauma from saddle sports. PFM training increases the strength, tone, and endurance of the PFMs and can ease saddle compression. Aside from committing to an exercise regimen, the practical application is to actively squeeze the PFMs for 1-2 seconds repeated 3-5 times, before, during and after cycling. Most cyclists will periodically take a break from sitting in the saddle by standing up and this provides a perfect opportunity to take the pressure off the perineum and to do a few PFM contractions to restore genital blood flow.
Keys To Reducing Risk Of Sexual Dysfunction
- Wear well-padded shorts.
- Shift from sitting to standing every 10 minutes or so, and if numbness and tingling occur, shift position or stand more often.
- Sit back firmly on your sit bones and not on your perineum: as you shimmy from nose towards rear saddle, you can feel the proper engagement.
- Invest in an ergonomic saddle tailored to your anatomy—make sure it is wide enough to support your sit bones, firm enough so that your perineum doesn’t sink and flat enough so that you don’t slide and that it doesn’t wedge up under your perineum.
- Adjust seat and handle bar height and angle to minimize compression.
- Do PFM contractions periodically while cycling and PFM exercises when not cycling.
- If you start having sexual issues, seek help!
Bottom Line: Cycling and other saddle sports may contribute to both male and female sexual dysfunction, especially for serious participants who spend prolonged time in the saddle. Pay careful attention to your perineum, a most valuable piece of human real estate.
Wishing you the best of health,
AndrewSiegelMD.com
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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback:
http://www.MalePelvicFitness.com
Co-creator of Private Gym pelvic floor muscle training program for men:
The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic muscle strength and tone. This FDA registered program is effective, safe and easy-to-use. The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximal opportunity for gains through its patented resistance equipment.
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