Penile Numbness in Bicyclists

Bicyclists and triathletes often log long miles in the saddle, and various muscular aches and pains are a common occurrence. Unfortunately, so too is damage to the male reproductive system. These tender areas need special consideration in order to avoid injury. The typical bike saddle makes contact with three main areas of the pelvis, the pubis in the front and the two ischial tuberosities (sit bones) in the back. These three points describe a plane and provide a stable framework from which the powerful leg muscles can work. Difficulty arises due to pressure on the nerves and blood vessels that travel to the penis, which get squeezed between the pubis and the front portion of the saddle.

Once thought to be rare, transient damage to the nerves on the underside of the penis can occur in approximately one fifth of cyclists engaging in long distance rides. A 1997 study done in Norway looked at riders in an annual bike touring race of 540 km (334 miles). By the end of the tour, twenty two percent of the riders surveyed had numbness or altered sensation in the penis. Impotence, defined as the inability to develop or maintain an erection, occurred in thirteen percent of the riders. This may be caused by injury to either the blood vessels or nerve.

Problems occurred in both beginning and experienced riders. Most of the abnormal symptoms resolved after a few days or a week, but a few riders had problems for several months. All the affected individuals in this particular study had everything eventually return to normal. The study also identified symptoms, such as weakness and numbness, due to compression of nerves (e.g., ulnar nerve) in the hand. In fact, neuropathy in the hands was correlated with neuropathy in the penis.

So what can you do to prevent injury to your penis? While riding, shift positions in the saddle or "stand" and stretch frequently. If you are doing a long touring ride like the MS 150, then regular breaks are a good idea. Good padded cycling shorts are a must. A "gel" type seat cover may help as well. However, too much padding can end up putting additional pressure on sensitive nerves. Finally, there are new seat designs emerging that look promising. Specialized makes a "V" shaped saddle with a central grove along the long axis of the saddle, designed to give more room where it’s needed. However, cyclists who move low on the handlebars and forward on the seat to get more power (e.g., time trial position) may find themselves on the tip of the "V" where there is no grove. I’ve even seen a seat design that looks like two cubes with a central pivot axis. The two cubes rotate relative to each other as the rider pedals. The rider thus has support for the two ischial tuberosities but no support (pressure) on the pubis. This would be expected to alleviate the pressure on the nerves and vessels, but would have less stability (two contact points instead of three) and thus would be unacceptable for many cyclists.

The take home message is that nothing is foolproof. Ride smart, be careful what you sit on, and pay attention to early warning signs. This will help keep everything in working order (and everyone happy).

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