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Bicycle saddle shape affects penile blood flow

Article  in  International Journal of Impotence Research · January 2003

DOI: 10.1038/sj.ijir.3900929 · Source: PubMed

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 International Journal of Impotence Research (2002) 14, 513–517
ß 2002 Nature Publishing Group All rights reserved 0955-9930/02 $25.00
www.nature.com/ijir

Bicycle saddle shape affects penile blood flow

S-J Jeong1, K Park2*, J-D Moon3 and SB Ryu2
1
Research Institute of Clinical Sciences, Chonnam National University Medical School, Gwangju, Republic of Korea;
2Department of Urology, Chonnam National University Medical School, Gwangju, Republic of Korea; and 3Department of
Occupational and Environmental Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea

The purpose of this study was to evaluate the effect of bicycle saddle shape on penile blood flow
during cycling. Penile blood flow was measured using a laser Doppler flowmeter in 20 potent male
volunteers. In a counterbalanced, crossover design, measurements were taken in the standing and
sitting positions, on either a narrow unpadded or wide unpadded saddle, before and after cycling
for 5 min. Before cycling, penile blood flow (ml=min=100 g tissue) was significantly decreased from
1.6
0.7 to 1.5
0.7 (P ¼ 0.010) on the wide saddle and from 1.7
0.6 to 1.0
0.5 (P < 0.001) on the
narrow saddle. After 5 min of cycling, the changes in penile blood flow on the wide and narrow
saddles were 0.34
0.49 and 70.38
0.49, respectively (P < 0.001). The narrow saddle is
associated with more significant reductions in penile blood flow and could be a source of blunt
perineal trauma, potentially leading to erectile dysfunction.
International Journal of Impotence Research (2002) 14, 513–517. doi:10.1038=sj.ijir.3900929

Keywords: saddle; cycling; penile blood flow; laser Doppler flowmetry; erectile dysfunction

Introduction development of such symptoms. Furthermore, cur-

Evidence, in the form of anecdotal evidence, case
reports and questionnaire-based studies, has accu-
mulated on patients who exercise on bicycles and
complain of impotence or erectile dysfunction. In
light of the popularity of cycling as a fitness activity
as well as a competitive sport, the potential impact
of cycling as an etiological factor in the development
of erectile dysfunction is significant. However,
relatively little attention has been devoted to
elucidating the specific relationship between
cycling and erectile dysfunction or the relevant
pathophysiology.
It has been proposed that the bicycle saddle might
affect penile blood flow during cycling.1 Genital
numbness and impotence have been reported in
some long-distance bicycle riders,2 and blunt trauma
to the corpora cavernosa has been considered to be a
risk factor for the subsequent development of
erectile dysfunction.1,3,4 It seems that anatomical
considerations of the structures compressed by the
load placed on the bicycle saddle might explain the
*Correspondence: K Park, Department of Urology, Chonnam
National University Medical School, 8-Hak-dong, Dong-Ku,
Gwangju 501-757, Republic of Korea.
E-mail: kpark@chonnam.ac.kr
Received 13 February 2002; Revised 04 June 2002;
accepted 12 July 2002
rent bicycle saddle designs may be responsible for
chronic injury to the perineum and thus may pose as
a risk factor for erectile dysfunction.
Some previously published, questionnaire-based
studies2 and case reports5 have reiterated many of
the typical clinical symptoms. Very few studies,
however, reported direct measurements of blood
flow in the flaccid penis during cycling.
The purpose of this study was to investigate the
relationship between the shape of the bicycle saddle
and penile blood flow during cycling using laser
Doppler flowmetry.
Materials and methods
A total of 20 healthy, potent, male volunteers (mean
age, 23 y; range, 20 – 26) participated in this study.
All subjects underwent routine evaluation for
impotence. All were free of any clinical history of
impotence, had no remarkable findings on routine
blood profiles, and had no history of diabetes,
Peyronie’s disease or vascular disease.
In a counterbalanced, crossover design, all parti-
cipants rode the same ergometer, while only the
saddle was changed between an unpadded narrow
type and an unpadded wide type. Baseline penile
blood flow was measured in the standing position
before beginning cycling. The effect of the bicycle
saddle was assessed by measuring the penile blood
 Saddle shape affects penile blood flow
S-J Jeong et al
514
flow in the seated position before and after cycling
for 5 min on each saddle. Pedaling resistance was
held constant for all subjects, and the participants
were instructed to pedal at 40 rpm while remaining
seated throughout the 5 min period. The volunteer
was allowed to rest for 5 – 10 min between the two
types of saddles.
The bike saddles used in this study are pictured
in Figure 1. The transverse diameters at the widest
points were 14 and 26 cm for the narrow and wide
saddles, respectively. Both were constructed of the
same materials and were assumed to vary only in
terms of the surface area available for distribution of
weight. As illustrated in Figure 1, the narrow saddle
shares the typical piriform shape seen in commer-
cially available narrow saddles. The wide saddle is
more heart-shaped.
Penile blood flow was measured using a laser
Doppler flowmeter (Transonic Systems Inc., Ithaca,
NY, USA). A surface-type flow probe was placed on
the glans penis and was held in place using
adhesive tape. The flow probe was connected to
the laser Doppler flowmeter, which was calibrated
against an internal standard. Readings of blood flow
were in units of ml=min=100 g tissue.
Penile blood flow measurements were taken in
the standing and sitting positions just prior to
beginning exercise and immediately upon cessation
of exercise. All measured values and calculated
values are reported as mean
s.d. in units of
ml=min=100 g tissue. Disparities in effect of postural
change (sitting or standing) and cycling (before and
after) were determined by calculating the changes in
blood flow. The effect of postural change is
expressed as the difference between sitting and
standing values on a given saddle. The effect of
exercise is expressed as the difference between post-
Figure 1 Photograph of the narrow and wide saddles. The
narrow saddle measured 14 cm in width at its widest points. The
wide saddle was 26 cm at its widest points.
International Journal of Impotence Research
and pre-exercise values in a single position (seated
or standing). Significant differences between means
were identified from values determined by the
paired t-test. Differences were considered statisti-
cally significant for a two-tailed hypothesis
(P < 0.05). Statistical analyses were performed using
SPSS 10.1 (Chicago, IL, USA)
Results
Trends in alterations of penile blood flow were
similar on both saddles with respect to position. The
data are summarized in Table 1. At a given time
point, the simple act of sitting on either type of
saddle significantly reduced penile blood flow
below baseline values, while blood flow signifi-
cantly increased with cycling. However, the two
types of bicycle saddles affected penile blood flow
differently in that sitting on the narrow saddle
caused significantly greater reductions in blood flow
than on the wide saddle both before and after
cycling (P < 0.001 in both). Penile blood flow after
cycling in the seated position on the narrow saddle
was the only post-cycling condition in which the
blood flow decreased below the baseline value.
Baseline penile blood flow measurements (in
ml=min=100 g tissue) were arbitrarily defined as
those recorded while standing prior to bicycling.
They were recorded with the subject standing erect
with a flaccid penis. There was no statistically
significant difference in the baseline values of
subjects using either the wide or narrow saddles
(1.6
0.7 and 1.7
0.6, respectively).
Penile blood flow was significantly decreased by
simply sitting on the saddle from 1.6
0.7 to
1.5
0.7 on the wide saddle (P ¼ 0.010) and from
1.7
0.6 to 1.0
0.5 on the narrow saddle (P <
0.001). The mean changes in penile blood flow
prior to exercise by sitting on the wide and
narrow saddles were 70.12
0.19 and 70.68

0.47, respectively. Sitting on the narrow saddle
resulted in significantly greater reductions in penile
blood flow (P < 0.001).
When the penile blood flow was measured with
the subject seated on the saddle after 5 min of
bicycling, the blood flows were 1.9
0.9 and
1.3
0.5 on the wide and narrow saddles, respec-
tively (P ¼ 0.009, P < 0.001 vs baseline, respec-
tively). The decrease in blood flow on either
saddle proved to be significant when compared
both to the respective post-exercise standing values
and baseline values (P ¼ 0.001, P < 0.001 vs standing
after exercise, respectively). Also, the decrease in
blood flow resulting from sitting on the narrow
saddle was significantly greater than on the wide
saddle (70.84
0.66 vs 70.19
0.21, P < 0.001).
After 5 min of bicycling, penile blood flow
significantly increased above baseline values to
 Saddle shape affects penile blood flow
S-J Jeong et al

Table 1 Summary of recorded penile blood flow measurement (in ml/min/100 g tissue) on each saddle type 515

Wide saddle Narrow saddle

Before cycling After cycling Effect of Before cycling After cycling Effect of
(%Baseline) (%Baseline) exercise (%)a (%Baseline) (%Baseline) exercise (%)a

Standing 1.6
0.7b,c 2.1
0.9 0.51
0.48 1.7
0.6b 2.2
0.9 0.46
0.83
(100) (131) (32) (100) (129) (27)
Sitting 1.5
0.7 1.9
0.9 0.45
0.49 1.0
0.5 1.3
0.5 0.30
0.52
(94) (119) (30) (59) (76) (30)
Effect of posture (%)a 70.12
0.19 70.19
0.21 0.34
0.49c 70.68
0.47 70.84
0.66 70.38
0.49c
(77.5) (79.0) (21)d (740) (738) (722)d
a
Effect of posture is the difference between sitting and standing values. Effect of exercise is the difference between after and before
exercise values.
b
Baseline values of each saddle type are defined as the before cycling, standing values.
c
P < 0.05.
d
Expressed as percentage of baseline.

2.1
0.9 and 2.2
0.9 in the wide and narrow
saddles, respectively (P < 0.001, P ¼ 0.025, respec-
tively). There was no statistically significant differ-
ence between the post-exercise values in the
standing position.
The combined effect of posture and exercise was
expressed as the change in blood flow determined
by subtracting the baseline value from the post-
exercise blood flow while sitting on the saddle. The
combined effects on the wide and narrow saddles
were 0.34
0.49 and 70.38
0.49, respectively
(P < 0.001). The negative value on the narrow saddle
reflects post-exercise blood flow on the narrow
saddle that is less than the baseline value.
Discussion
Penile blood flow increases with exercise as long as
there is no external force applied to impede blood
flow, as suggested by the measurements in the
standing position. After 5 min of bicycling, an
increase in blood flow to approximately 130%
baseline was observed in the standing position,
irrespective of saddle type. On the other hand,
penile blood flow decreases upon sitting on the
saddle. These reductions in penile blood flow occur
in the face of physiologic increases in penile blood
flow after cycling, and, in the case of the narrow
saddle, the act of sitting reduced penile blood flow
to 76% of baseline while the same conditions on the
wide saddle reduced blood flow to 119% of
baseline.
The observed increase in blood flow could
probably be explained as a combination of a
bystander effect and a direct effect of exercise.
Sullivan et al6 demonstrated a near-linear relation-
ship between blood flow to the lower extremity and
oxygen consumption. Increased perfusion of the
perineal area is most likely secondary to increased
blood flow to the lower limbs. Additionally,
although the penis is hardly considered the ‘exercis-
ing limb’ during bicycling, anatomic considerations
and the results of this study suggest that the
perineum undergoes variable yet continuous
compression potentially causing a condition of
increased oxygen demand, albeit due to decreased
perfusion rather than increased metabolic activity.
In fact, Sommer et al7 reported no increase in penile
blood flow when cycling in the standing position.
Whether the increase in blood flow is simply a
reflection of increased blood flow to the entire lower
extremities or a reflection of a compensatory
physiologic response to increased oxygen demand
cannot be concluded from the data.
Explanation of the reduction in penile blood flow
caused by sitting on the saddle should begin with
anatomical considerations of relevant structures in
the lower abdomen and perineum. The common
penile artery lies medial to the inferior pubic ramus
and bifurcates into the cavernosal and dorsal arteries
just below the symphysis pubis. They
are continuations of the internal pudendal artery in
the male, which originates from the anterior trunk of
the internal iliac artery. The pudendal nerve passes
through Alcock’s canal and comes out below the
symphysis pubis to provide sensory innervation of
the perineum and genitals. Given these anatomic
positions, the penile arteries and pudendal nerves
may be compressed between the bike saddle and the
pubic bones during bicycling.8
It is perhaps noteworthy that laser Doppler
flowmetry was targeted at the dorsal artery of the
penis rather than the cavernosal artery, which
provides the principal blood supply to the glans
penis. In defense of the selected approach, blood
flow in the cavernosal artery is difficult to detect
in the flaccid penis, and, since both the dorsal and
cavernosal arteries branch from the penile artery, it
is believed that reduction of blood flow in the
dorsal artery is indicative of reduction of blood

International Journal of Impotence Research

 Saddle shape affects penile blood flow
S-J Jeong et al
516
flow in the cavernosal artery. While previous
noninvasive methods have focused on the transcu-
taneous measurement of penile oxygen pressure,7
our study offers a method of determining accurate
blood flow measurements through laser Doppler
flowmetry.
There may be an additional role of the bony pelvis
in the reduction of penile blood flow aside from
simple compression at the pubic arch. The trans-
verse diameter of the inferior pelvic aperture
(bituberous diameter) is the distance between the
medial sides of the lower limits of the ischial
tuberosities. The mean bituberous diameters in
adult males and females are 85 mm and 118 mm
respectively.9 Any portion of the saddle anterior to
the ischial tuberosities that may be narrower than
the bituberous diameter would effect wedge com-
pression to the perineum.
It is common knowledge that the ischial tubero-
sities are normally the principle points of load
bearing in the seated position. When sitting in a
chair, the weight of the body is primarily distributed
over the corresponding surface area of the gluteal
region and part of the proximal posterior thigh
(hamstring). On a bicycle saddle, the two ischial
tuberosities effectively form a fulcrum about which
the body weight can be pivoted, making anterior,
neutral and posterior sitting postures possible. The
anterior portion of the bike saddle literally applies
wedge compression to the inferior aspect of the
urogenital region of the perineum and to part of the
anal region. Severity and area of perineal compres-
sion would vary with body weight and the degree of
forward leaning. Kerstein et al10 reported that
weight correlated with reduced penile pressure
due to perineal compression in cycling.
Blunt trauma to the perineal region of the
corpora cavernosa has been considered a risk factor
for the subsequent development of erectile dysfunc-
tion.1,3,4 Munarriz et al1 noted that sports-related
accidents were the most common type of blunt
injury to the perineum leading to erectile dysfunc-
tion. Anderson et al2 performed a survey-based
study of amateur and professional cyclists after a
single bicycle race, where 21% of males experi-
enced genital numbness, and 13% of males
reported impotence.
Susceptibility to injury from blunt trauma can
derive from the structure being fixed and related to a
firm undersurface.1 Structures of particular concern
for traumatic wedge compression by a bicycle saddle
are those found in or passing through a roughly
triangular space that is bordered bilaterally by the
pubic arch, with the symphysis pubis at the apex,
and the ischial tuberosities forming the base. These
are essentially the same structures entertained by
the anatomic considerations.
Both vasculogenic and neurogenic mechanisms
seem plausible as explanations of the development
of bicycling-associated perineal symptoms and
International Journal of Impotence Research
erectile dysfunction. Anderson et al proposed nerve
entrapment as an adverse effect of long-distance
cycling.2 Our study demonstrated significant reduc-
tions in penile blood flow immediately after a brief
exercise period. It was not the intention of the
study to investigate neurogenic mechanisms per se,
and it is believed that the experimental design
essentially eliminates the possibility of developing
nerve block in the time allotted for the
study. However, it would be of interest to investi-
gate the temporal relationship between the two
mechanisms.
A significant unresolved issue is the transition
from acute to chronic reductions in penile blood
flow. While it is assumed that normal subjects
would quickly recover after a 5 min bicycle ride,
there may be a point at which a normal subject does
not recover. Unfortunately, our study design did not
include monitoring the volunteers until flow
returned to baseline values.
It would be of particular benefit if an animal
model of load (body weight)-induced perineal
trauma could be developed for further investigation
into the pathophysiology of penile artery insuffi-
ciency. Chevalier et al11 published a case report of
endofibrosis of the external iliac artery in a small
number of professional bicycle racers. The sug-
gested pathophysiology involved a combination of
anatomic and biomechanical considerations, arterial
stress of the high flow state, increased blood
pressure and subsequent turbulent flow. This seems
to represent a type of vascular pathology that is
unique to professional bicycle racers; however, it is
quite possible that blunt perineal trauma could
present a more common form of vascular pathology
that is not limited to professionals.
Conclusions
The shape of the bicycle saddle clearly affects penile
blood flow. This is of particular concern during
exercise and in the post-exercise state, where the
narrow saddle demonstrates more significant reduc-
tions in penile blood flow than the wide saddle. In
light of the results of this study and mounting
anecdotal evidence of erectile dysfunction in avid
cyclists, it appears that reduction in penile blood
flow caused by saddle shape could serve as an initial
step in the development of vasculogenic impotence
in some individuals. While behavior modifications
(eg increasing the number of rests, standing on the
pedals to relieve perineal pressure, etc.) might help
to diminish this effect, industry-wide modifications
in saddle design might be required to completely
eliminate a potentially detrimental side effect in the
health-promoting sport of cycling.

References
1 Munarriz RM et al. Blunt trauma: the pathophysiology of
hemodynamic injury leading to erectile dysfunction. J Urol
1995; 153: 1831 – 1840.
2 Andersen KV, Bovim G. Impotence and nerve entrapment in
long distance amateur cyclists. Acta Neurol Scand 1997; 95:
233 – 240.
3 Levine FJ, Greenfield AJ, Goldstein I. Arteriographically-
determined occlusive disease within the hypogastric-
cavernous bed in impotent patients following blunt perineal
and pelvic trauma. J Urol 1990; 144: 1147 – 1153.
4 Armenakes NA et al. Posttraumatic impotence: magnetic
resonance imaging and duplex ultrasound in diagnosis and
management. J Urol 1993; 149: 1272 – 1275.
5 Bond RE. Distance bicycling may cause ischemic neuropathy
of penis. Physician Sports Med 1975; 3: 54 – 56.
View publication stats
Saddle shape affects penile blood flow
S-J Jeong et al
517
6 Sullivan MJ, Binkley PK, Unverferth DV, Leier CV. Hemo-
dynamic and metabolic responses of the exercising lower limb
of humans. J Lab Clin Med 1987; 110: 145 – 152.
7 Sommer F et al. Impotence and genital numbness in cyclists.
Int J Sports Med 2001; 22: 410 – 413.
8 Melman A, Christ GJ, Hirsch MS. Anatomy and physiology of the
penis. In: Bennett AH (ed). Impotence: Diagnosis and Manage-
ment of Erectile Dysfunction. WB Saunders: Philadelphia, PA,
1994, pp 18 – 30.
9 Soames RW. Skeletal System. In: Williams PL (ed).
Gray’s Anatomy: the Anatomical Basis of Medicine and
Surgery, 38th edn. Churchill Livingstone: New York, 1995,
pp 425 – 736.
10 Kerstein MD, Gould SA, French-Sherry E, Pirman C. Perineal
trauma and vasculogenic impotence. J Urol 1982; 127: 57.
11 Chevalier JM et al. Endofibrosis of the external iliac artery in
bicycle racers: an unrecognized pathological state. Ann Vasc
Surg 1986; 3: 297 – 303.
International Journal of Impotence Research