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Results:The reported incidence of bicycling related urogenital symptoms varies considerably. The most common bicycling associated urogenital problems are nerve entrapment syndromes presenting as genitalia numbness, which is reported in 50–91% of the cyclists, followed by erectile dysfunction reported in 13–24%. Other less common symptoms include priapism, penile thrombosis, infertility, hematuria, torsion of spermatic cord, prostatitis, perineal nodular induration and elevated serum PSA, which are reported only sporadically.
4.5. Penile blood flow during cyclingArterial insufficiency is another possible cause of genital numbness and impotence [19. Cutaneous penile oxygen pressure, which is believed to correlate with penile blood flow, decreases significantly during cycling [[9], [20], [21], [22]]. The extent of the decline in blood flow was correlated with the cycling position and the type of the saddle. Cycling in reclining position, in which the perineum is not compressed, did not alter penile perfusion. Conversely, cycling in the upright-seated position compresses the pudendal arteries in the perineum and consequently decreased penile blood flow by approximately 70% [21. Standing up while cycling improved penile oxygenation back to its normal level before cycling [20. Although cycling in the seated position invariably compromised penile perfusion, the type of the saddle significantly affected its extent. An ergonomic wide saddle with absent nose provided the maximum protection against penile hypoperfusion (20.3% decrease in comparison to 82.4% using a standard narrow saddle) [22. Similarly, Broderick reported that sitting on a bike saddle decreases penile blood flow following intracavernous injection of PGE1 [23. More recently, Jeong et al., employed an investigational, more accurate laser Doppler flowmetry technique, determined the effect of bicycle saddle shape, (either a narrow unpadded or wide unpadded saddle), on penile blood flow and concluded that the shape of the bicycle saddle clearly affects penile blood flow as cycling on the narrow saddle caused more prominent decline in penile blood flow [24. Hypoxemia of the penis subsequently causes corporal connective tissue synthesis, apoptosis of trabecular smooth muscle cells and penile fibrosis which are induced by the synthesis of transforming growth factor-beta 1. The loss of trabecular erectile tissue along with deposition of connective tissue result in impaired penile expandability which may cause permanent ED due to veno-occlusive dysfunction [25.
