This is your penis. This is your penis on a bike saddle.

I couldn't sleep at all last night.  I found myself wide awake and pacing about the COMO CYCO headquarters in the wee hours.  I would like to think it was because I am frustrated at not being able to take advantage of this amazing weather to ride because of my day job, but it was more likely the entire block of asiago cheese I ate for dinner.  At any rate, it is times like these, that I wish I had a Snoozatron.

But alas, unlike Grommit, all my dog does when I get up in the middle of the night is rob me of the warm spot I made in the bed.  Being wide awake, I decided to log on to the COMO CYCO email account and get a head start on some reader mail and make good use of this time.  Lo and behold, what did I find in my inbox but an email from the Canadian Health & Care Mall making me an incredible offer!

As a belated Valentine's Day promotion, they are offering a Cialis + Viagra "Power Pack" combo that I was encouraged to "ORDER NOW!".  I can only imagine that the irreversible and unrelenting erection that would ensue from taking a combination of Cialis and Viagra would make the COMO CYCO GEEC ecstatic, especially when she was driving me to the ER.

But this reminded me of a post (no pun intended) way back in January we wrote entitled "Cars are hard, Cyclists are not: Part I" in which I poked a little fun at a scientific article authored by Dr. Steve Schrader titled "Cutting off the nose to save the penis" which was in reference to the dangers of bicycle saddles on the sexual health of men and women.  Dr. Schrader was kind enough to comment on my post which started a bit of an email exchange between the two of us.  Long story longer, he agreed to let me interview him and answer some questions about the effect that conventional bike saddles can have on male cyclists in particular, which I now post below for you.  What's exciting is that Dr. Schrader is a Mizzou Grad, so has a special connection with not only cycling, but our humble home of COMO and The University of Missouri.

CCPB: Can you briefly tell me about your educational background and current position with the CDC?

Dr. S:  I received my Ph.D. from the University of Missouri in 1978 in reproductive physiology. I did my post-doctoral research in reproductive biology at the University of Miami (FL). I was on the faculty at Roosevelt University for 2 years before coming to NIOSH in 1983. I currently lead a reproductive health assessment team within NIOSH which conducts research studies on the reproductive health effects of potential workplace exposures.

The National Institute for Occupational Safety and Health (NIOSH) is a sister agency to OSHA that was created to conduct occupational safety and health research and is one of the centers of the Centers for Disease Control and Prevention (CDC).

CCPB: What got you interested in the impacts of cycling on male reproductive health?

Dr. S:  There is a congressionally mandated program which requires NIOSH to investigate health hazard concerns (www.cdc.gov/niosh/hhe/ ). A union representing a bicycle patrol unit requested a health hazard investigation because of urogenital numbness and impotence complaints of their bike officers. Being the lead investigator in male reproductive health I conducted this investigation and this was the first bike publication (Schrader, S.M., M. J. Breitenstein, J.C. Clark, B. D. Lowe, and T. W. Turner. 2002. Nocturnal Penile Tumescence and Rigidity Testing of Bicycling Patrol Officers. Journal of Andrology 23:927-934). Our agency not only finds health issues but also tries to find workable solutions, thus the ensuing research.

CCPB: Are you a cyclist? If so, which saddle do you use?

Dr. S:  I am not an avid cyclist, but instead a grandpa who rides on a Sunday afternoon with the grandkids. I do use a noseless saddle, as does my daughter and I just bought one for my grandson whose new bicycle is now big enough to be fitted with one. I do not want to say which brands because I must be very careful to make sure it does not look like I am endorsing a product.

CCPB: Dr. Irwin Goldstein, another well-respected leader in this field of research, seems to believe that all cycling is bad for men due to the reported issues related to saddle pressure on the perineal region. But is this necessarily true? In other words, if all men are not negatively affected by riding nosed-saddles, then do certain risk factors increase the risk in some, and if so, what might they be?

Dr. S: Dr. Goldstein probably overstated the problem. Like any disease or injury there is not 100% prevalence, we just saw that with H1N1. We really do not know the prevalence of this, partially because men are not willing to volunteer this information and partially because it depends on what we are really defining as the problem. The most common complaint I get from male cyclists is maintaining their erection, they get an erection but does not last as long as needed. That is not impotence in the strictest definition. This does not happen the first time you sit on a bike saddle and is progressive. There are probably many risk factors involved. Many of the risks factors may be those for other cardiovascular diseases. Thus, cycling is a great cardiovascular exercise but the traditional saddle may be the most dangerous to the penis in those who need to cycle the most. When you sit upright on a bicycle saddle you put about 25% (over 50% in extreme aero positions) of your body weight on the saddle. We actually measure the pressure and know that it is high enough to constrict blood flow and many cases completely constrict blood vessels. This has also been shown by others looking at pO2 levels, Doppler blood flow, and MRI. Prolonged and repeated constriction of these vessels causes blood flow issues in some men. It may be a loss of resilience of the vessels to completely recoil from the constriction or an injury potential where plaque builds. For some extreme cases by-pass surgery is needed to restore erections. There are no data showing that bicycle fit or riding style can alleviate the pressure. Padding and gel disperse the pressure more evenly but can not reduce it. Pressure is the weight times the surface area, so if the saddle surface stays constant so will the overall pressure. Certainly, sitting back on the sit bones is a good recommendation but does not remove perineal pressure completely. Getting up off the saddle should restore blood flow, but does this add to repeated trauma when one sits down and constrict the vessels again? We do not know the risk factors nor do we know what level of sexual dysfunction is accepted to men before they call it problem. As I have told cyclists who argue about the scientific results or prevalence of the disease. “It’s your penis, are you willing to take the risk when there is a good, proven alternative?”

CCPB: Recently an article was published by Bressel et al which indicated that no-nose saddles decreased perceived stability and steering ability in cyclists, thus increasing pressure applied through the hands on the handlebars as the cyclists redistributed much of their body weight forward and used the handlebars to steer more. Could you comment on this article?

Dr. S: We actually wrote a letter to the editor about this paper. We stated:


“We question a premise that perceptions of bicycle stability assessed after use of the saddle for only eight minutes can reliably predict successful adaptation to the bicycle saddle. We are concerned that inferences about perceived bicycle stability, based on such a short duration test session, may lead bicyclists looking to alleviate harmful perineal/groin pressure to prematurely reject the no-nose, or full cut-away, saddle designs.”

“The Bressel et al. study soundly confirms what anecdotal reports have suggested – adaptation to cycling with a full cutaway saddle is not immediate. However, it is our opinion that users looking to reduce exposure to perineal pressure from their bicycle saddle should not be deterred by perceptions of instability in the first few minutes of use of a no-nose saddle. The Bressel et al. study raises an important question about the duration of an evaluation period for ergonomic interventions and how this affects user acceptance. Recent data on no-nose bicycle saddles suggests that users who are motivated to reduce a source of discomfort, and possibly more severe symptoms, are willing to spend more than eight minutes adapting to an intervention that reduces the risk factor to which they are exposed.”

My grandson had much greater stability concerns which lasted much longer when I took his training wheels off. The stability issues related to the noseless saddles are much less and the rider adapts to it fairly readily.

We were concerned about increased pressure to the arms and hands when using a noseless saddle and conducted the study by Lowe et al (Lowe, B., S. Schrader, and M. Breitenstein. 2004. Effect of Saddle Design on the Perineal Pressure of the Bicyclist. Sports Medicine. Med Sci Sports Exerc 36:1055-1062.) In this study we did not see an increase in hand pressure. However, in our most recent study where the men used the noseless saddles for 6 months we did see a significant increase in hand pressure. On the NIOSH saddle blog (www.BlogSaddles.com) is discussed by Sgt Andruzzi from the Chicago Police Department.

Joe Andruzzi says:

"The one issue that has risen with officers riding a no-nose saddle is wrist pain and/or hand numbness. This can be directly associated to improper seat angle. Once properly fit these issues are usually alleviated. Generally speaking, most cyclists are not "professional" riders. Many are ignorant to the importance of saddle angle and without the nose of the saddle they tend to want to tilt the saddle forward to compensate. While the benefits of using a no-nose saddle can not be overstated, it is equally important to ensure a rider has proper seat angle. To do otherwise only creates the situation for other health problems to arise."

CCPB: Much of your work has involved the use of subjects who ride bikes for their occupation, such as bicycle police officers. Has anyone investigated competitive cyclists (road or mountain bike) to see if erectile dysfunction is as prevalent in those populations? If not, what would you predict the findings would be of such an investigation and why?
 
Dr. S: Most of the 60+ manuscripts associating sexual dysfunction and cycling were studies conducted investigating a wide gamut of cyclists. We studied occupational cycling because that was our agency's charge.  For those who ride in more aero position, the perineal pressure goes up as the rider rolls forward on the ischial rami and off the ischial tuberosities.  Every time I present this bicycle saddle I have individuals (both male and female) “hang around” after the talk or contact me later talk about their “issues” and the bike saddle. These seminars are not only given at police departments but also to general audiences on college campuses.
CCPB: I'm assuming you have no financial interest in a noseless bicycle saddle company, correct? If not, are all noseless saddles created equally? Are there some you would be a stronger advocate for?

Dr. S: I do not have any financial interest in any bicycle saddle company. If fact it is against federal law for me have any financial or consulting relationships with these companies because I am studying their products.

CCPB: Can you provide some links to some noseless saddle manufacturers?


Yes. http://www.healthycycling.org/ are the only no-nose saddles I am aware of. It needs to be noted that this is not a federal government website and the NIOSH is not responsible for its content.

I'd like to thank Dr. Schrader for his time and expertise on this subject.  He has been more than generous in providing me with a tremendous amount of information.  And if anyone reading this would like more information, please feel free to email me, and I can pass along some more material that Dr. Schrader provided me with.
 
Pedal on!