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Bicycle Riding: Erectile Dysfunction and Urethral Stricture Risks

While bicycle riding is a good way to exercise, it can increase your risk for developing erectile dysfunction(ED) and urethral stricture (weak urinary stream).

Why is bicycle riding associated with ED risk?

The penis is attached deep within the scrotum and does not end, as it appears to, at the pubic bone. Half of the penis is actually under the skin and attached to the pelvic bones between the scrotum and the anus. Therefore, any blow to the area between the anus and scrotum can potentially injury the penis or urethra. The primary problem with bicycle riding is the bicycle saddle. While the rider is sitting on a narrow bicycle saddle or its protruding nose, the compressive forces push the nerves and blood vessels within Alcock’s canal against the bony surface of the pelvic bone, transiently stopping blood flow to the genitals.

Alcock’s canal is where the nerves and arteries travel on their way to the penis. The penile artery can get crushed (sandwiched between the force and the bone), injure the artery lining, and cause atherosclerosis (inflammation and narrowing) of the penile arteries. The injury can either be from a sudden blow, such as falling onto the bicycle bar or from chronic repetitive small injuries, after weeks and months of prolonged bicycle riding. Focal endothelial injury of the arteries within Alcock's canal can compromise blood supply to the penis and result in ED either immediately, or delayed till years later.

What is bicycle riding associated with urethral stricture risk?

Prolonged riding can even cause numbness and tingling in the penis and scrotum. Bicycle saddles with a long nose also compress the bulbar urethra and after repetitive trauma to this area, can compromise urethral blood flow and increase chances for a stricture (urethral narrowing and slow urinary steam). Straddle injuries (falling on the bicycle bar) can cause of a crush injury of the bulbar urethra between the bar and the pubic bone. This typically occurs with BMX or mountain biking. Such strictures are typically short and with severe fibrosis of the surrounding urethral tissue.

What’s the risk of avid bike riding and ED?

The relationship between ED and bicycling was first demonstrated in the Massachusetts Male Aging Study (MMAS), a cross-sectional survey of 1709 men in their 40’s to 70’s. The random sample included a variety of cyclists, such as recreational and occasional riders, stationary bikers, and serious sport cyclists. A key finding of the MMAS was the difference between moderate cycling (< 3 hours per week), or “avid” cycling (>3 hours per week), and the development of ED. Those who cycled at least 3 hours per week were found to have an odds ratio for developing moderate or complete ED of 1.72. (Odds ratios > 1.5 are considered a health risk) Therefore, men who cycle for more then 3 hours per week are more likely to cause potential artery blockage and long-term damage to their penis. Furthermore, any compromise to penile blood supply will also compromise urethral blood supply.

Ultimately, you should weigh the risks versus benefits of “avid” bicycle riding. If you choose to ride, however, we suggest using a comfortable and wide saddle without a “nose”. Bicycle seats without a nose cause the least compromise in blood flow to the penis and urethra. Furthermore, minimize bike riding to less than 3 hours per week,if possible.

Diagram of three bicycle seats. Two with bases and no nose. One with narrow seat and long nose.