Soon thousands of cyclists will take to the roads of Cape Town to do the 109km Cape Argus Pick and Pay Cycle Tour.

How many men would choose not to do the ride if they agree with Dr Irwin Goldstein, a urologist at Boston University Medical Centre? He treats more than a 100 impotent men each week and says that at least six of these can trace the cause of their impotence to cycling.

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The clinical evidence behind this theory lies in the anatomy of the male perineum. The extension of the corpus spongiosm into the perineal area, between the ischial tuberosities, expose the penile arteries and nerves which traverse this area to the ongoing disparity between the weight of the cyclist and the upward force of the saddle.

Hours spent on the bicycle create an accumulated compression injury of these structures. Practically that means: a 70 kg man sitting on his bicycle seat is supporting this 70kg weight exactly on the artery to his penis. This pressure can lead to blockages in the arteries that feed blood to the penis – blockages that line up exactly where a bike seat fits a man’s perineum.

Insufficient data?
Now, just before you sell your bike, and stop riding for ever, Dr Harin Padma-Nathan, from University of California and an impotence specialist, says that the current data is insufficient to support the hypothesis that bicycling is a risk factor for impotence. He does, however, not doubt a real issue exists in this area, but would rather than terminate cycling, see that males are given correct information about training, are measured up correctly for their bikes, and get out of the saddle regularly.

But Goldstein is adamant, “I see men that can’t even feel their penises, because of severe nerve damage. They can’t ejaculate, can’t have an orgasm. What’s their crime in life? They ride a bike. Personally I like having erections. I wouldn’t ride a bike in its present design form. Why take the chance?”

Tips
Most experts agree that even though we don’t know how common cycling impotence may be, or how much riding it takes to cause a problem, there are some common-sense suggestions men can follow in the meantime.

• Penile numbness and excessive genital shrinkage are warning signs that there may be too much pressure on the perineum. The nerves in the perineum are being pinched, which means that the artery that feeds the penis is also being compressed. If you experience groin numbness while riding, get up on the pedals and ride out of the seat for a distance, or get off the bike and take a break.
• Sitting back on the buttocks as much as possible while riding, takes the pressure off the frontal area.
• Lowering the front part of the saddle, or at least making it level, relieves pressure on the penis while riding.
• Fit a broader or more heavily padded seat which spreads the load to the ischial tuberosities (the sit bone), rather on the perineum.
• Check to see that the legs are not fully extended to the bottom of the pedal stroke. The knees should be slightly bent to support more of your weight.
• Be wary of spending significant time on aero bars – they encourage riding on the nose of the saddle.
• Stand up every 10 minutes or so to encourage blood flow.
• Heavier riders may be more at risk of arterial compression damage because of the greater weight that is placed on the perineum. You should also get off the saddle as frequently as you would on a regular bike and be certain that it is set up the same in riding position.
• Make sure the top tube of your bicycle is three to four inches below the perineum.
• Consider padding the top tube.
• Get out of the saddle when riding over any bumpy surface like railroad tracks, trail debris, or washboard terrain. Use your legs as shock absorbers.
• Consider a recumbent bicycle or stationary cycle. The reclining position on a chair-like seat, limits any chance of compression or impact injury. Alternatively, spinning – the new exercise craze – may be better, because you spend time out of the seat, standing on the pedals.

- (Dr Elna McIntosh, Health24 and Dr Denis Cronson, Men's Clinic International)
 

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