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Advice to cyclists: sit up straight to avoid ED.

ATLANTA -- It's not only the bicycle seat that causes erectile dysfunction in some men who cycle--it may also be the way they sit on it, according to a poster presented at the annual meeting of the American Urological Association.

Erectile dysfunction (ED) resulting from penile hypoxia can sometimes occur after prolonged bicycling, particularly when men who ride road or touring bikes lean far forward, as when using dropped handlebars, or "aero bars." ED may happen even when riders use grooved seats in an attempt to reduce pelvic compression.

One new solution may be to sit up straight, or at least somewhat straighter, thereby reducing compression on the internal pudendal artery and nerve, said Dr. John M. Gemery, professor of radiology, Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

The problem of ED is theoretically less likely to occur in racing cyclists who spend much of their riding time standing up. But men who ride for a few hours on flat surfaces and stay bent forward over the handlebars may be more likely to end up with ED, he said in an interview.

Much effort has been put into designing bicycle seats that have a central groove or cutout to reduce perineal pressure. Studies show that it does help when a male rider uses a grooved seat. But penile artery compression can occur even with a grooved seat when the rider leans far forward. No matter what seat a rider chooses, leaning forward causes higher compression, compared with riding upright, Dr. Gemery said.

He became interested in cycling-induced ED when he was an interventional radiology fellow at Boston Medical Center, working with Dr. Irwin Goldstein. "Dr. Goldstein started the concern about bike seats and ED, and I was doing angiograms for him, so I also became interested in the problem. We were trying to figure out where, in fact, the blood vessels to the penis get compressed."

Continuing this research at Dartmouth-Hitchcock, Dr. Gemery developed three-dimensional digital models created from CT scans of the pelvis of an adult male volunteer, as well as three bicycle seat designs. He worked closely with Dr. Ajay Nangia, a professor of surgery (urology) at Dartmouth-Hitchcock Medical Center and an expert in male infertility and microsurgery. The seats were chosen to represent the full spectrum of designs.

Dr. Gemery and his associates then took lateral radiographs of the volunteer sitting on a bicycle in various positions to determine the position of the bony pelvis relative to the bicycle seat. They found that the most likely site for compression of the internal pudendal arteries was between the bicycle seat and the pubic symphysis.

"As the rider leaned further forward, the pubic symphysis got progressively closer to the seat, so that the space between the undersurface of the pubic symphysis and the top of the seat got smaller. These arteries have to run underneath the pubic symphysis to get out to the base of the penis, so as that space between the seat and symphysis closes, there is less space for those arteries and in fact, for the pudendal nerves as well," Dr. Gemery explained.

Although a seat design with a central groove should reduce the risk of compression and therefore ED, rider positioning appears to have a potentially equal or even greater role in preventing the problem, Dr. Gemery concluded.

His study was based on just one subject, and more follow-on research needs to be done to confirm if it will be true in riders with varying anatomy. But in this one case, "There was more space with the subject in a mild lean with a narrow racing seat than when using aero bars and a grooved seat," he said.

"It may be that riders don't have to go out and buy expensive seats, they just need to remember to sit up from time to time or ride at a more upright angle," he said.

BY FRAN LOWRY

Orlando Bureau
COPYRIGHT 2006 International Medical News Group
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Article Details
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Title Annotation:Urology; erectile dysfunction
Author:Lowry, Fran
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:Aug 15, 2006
Words:651
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