When he talks about bicycles, Irwin Goldstein, M.D., uses the
same tone that other physicians reserve for cigarettes.
"Men should never ride bicycles," he says
matter-of-factly. "Riding should be banned and outlawed. It's the most
irrational form of exercise I could ever bring to discussion."
In his office at Boston University Medical Center, Dr.
Goldstein treats six men a week on average, whom, he says, have become impotent
from riding a bicycle. Overall, this urologist estimates there are about 100,000
men who have lost the ability to get or maintain satisfactory erections because
of penile damage inflicted by either the bike's top tube or its saddle.
This is the message Dr. Goldstein is vociferously delivering in media
interviews, university lectures and medical seminars nationwide. Considered one
of the country's leaders in impotency research, Dr Goldstein helped engineer the
shift in treating male sexual dysfunction from a psychological problem to a
chiefly physical one. No doubt, he is an outspoken revolutionary, but he is a
revolutionary with credentials. Right now, armed with a new study, he's out to
overthrow bicycling.
Last May, Bicycling exclusively obtained the results of Dr.
Goldstein's new study on the effects of saddle pressure and compression on the
penile artery. The data has yet to be published in a medical journal and as
such, many of the details cannot be released for verification, discussion or
attack. But the results were enough to convince us that what may at first seem
like an outlandish claim (before this article was assigned we had yet to hear of
a single instance of saddle-related impotence) deserves attention. And as we
began to research this piece, we discovered the problem may be more prevalent
that we initially believed. It was, in fact, a problem one
of our own staff had been secretly battling. We are not telling you not to
ride your bike. In fact, with the exception of Dr. Goldstein, all of the doctors
we spoke with stated that the health benefits of cycling far outweigh what is
still an unknown risk. Just listen up.
Dr. Goldstein first made headlines in the late 80's, by suggesting that
bike manufacturers either eliminate the top tube (as with a traditional girls'
design) or heavily pad it to protect boys and men who might land on it. Later
studies of his, reported in the Journal of Urology, found that a
150-pound cycling pedaling at 20 mph could fall onto a top tube located three
inches below the crotch with a force equal to a quarter ton.
The majority of bicycle-related impotency cases Dr. Goldstein treats stem
from this kind of accident. Take Kyle Cashman (the names of Goldstein's patients
have been changed), for example. At age seven, he crashed his father's bike and
slammed his crotch against the top tube. Other than the immediate pain, he felt
no adverse effects until he reached puberty. Then he started experiencing
erection problems that he lived with for almost a decade before seeking medical
attention. An X-ray enabled Dr. Goldstein to pinpoint where the artery that
sends blood to the penis had been damaged.
Few have paid attention to Dr. Goldstein's warnings. In fact, within
cycling circles he was shrugged off and regarded as somewhat of a kook. But as
he developed a nationwide reputation, he began to see more impotent riders who
couldn't point to any one accident as a potential cause. This eventually led him
to explore the role saddle compression may play in cycling.
Richard Belmont, a 54-year-old attorney, never had any sexual-performance
problems. But after cycling almost 200 miles curing a two-day charity ride last
summer, he suddenly became impotent. Pedaling a new road bike equipped with a
racing saddle and an aero bar, he noticed that his penis was numb for most of
the event. After experiencing erection difficulties during the next six months,
he finally visited Dr. Goldstein, who spotted arterial damage at the base of the
shaft.
Greg Jackson, a 33-year-old computer programmer, always kept himself in
great shape. He swam, ran and bicycled. But after a long mountain bike ride on
rough terrain, he experienced pain that went beyond the usual aches. Its
epicenter was near his penis, which wouldn't get as hard or as erect as it used
to. When he eventually consulted Dr. Goldstein, he learned that his main penile
artery had become clogged.
Jim Broderman, 55, never had a bicycle accident or any sexual misfire.
But after a heart attack, he started riding a stationary bicycle. Seven years
later, after pedaling 50,000 miles, his heart was strong, but his penis had gone
limp. X-rays uncovered no abnormalities in the penis itself, but right where it
attaches to the pubic bone (exactly where the bicycle seat fits), Dr. Goldstein
found arterial scarring that was hampering blood flow.
To understand what may have happened to these men (and, most important,
how you can keep it from occurring in your neighborhood), you need to know a few
things about male anatomy. The penis is a hydraulic system. During sexual
stimulation, its twin chambers fill with blood until it's firm and erect. After
stimulation ends or there's ejaculation, the blood leaves and the penis softens
again. The trigger for this increased blood flow is nerve impulses that
originate in the brain and race down the spinal cord to the penis. All this
happens very fast -- typically three to five seconds from stimulation to
erection in a young male.
All this essential wiring (nerves, blood vessels) is funneled through an
area called the perineum, which lies between the sit bones. To better understand
what we're talking about, squat and sit on a low-lying step or curb. You'll feel
your weight being supported by your pelvis, as evolution intended. But when
you're riding a bicycle, Dr Goldstein explains that your weight is being focused
between these sit bones, and that's where the arteries and nerves that feed the
penis are located. Since they're essentially unprotected, they're prone to
damage from impacts and, he suggests, possibly even from chronic saddle
pressure.
"Fifty percent of the penis is actually inside the body," explains Dr. Goldstein. "When
a man sits on a bicycle seat he's putting his entire body weight on the artery
that supplies the penis. It's a nightmarish situation."
To study how such pressure might compromise sexual performance, Dr.
Goldstein set out to measure the degree of compression in the cavernosal artery
that feeds the penis. He used three different methods (X-ray, ultrasound and
arterial pressure readings) to gauge the effects of sitting on a narrow unpadded
saddle, a wide padded saddle, and a chair. From a test group of 100 impotent
patients studies over 10 months, he determined that it takes only 11% of a
person's body weight to compress the artery. He measured a 66% average reduction
in blood flow through the artery when subjects were on the skinny saddle, 25%
when on the wide saddle, and no change when seated on the chair. This led Dr.
Goldstein to conclude that, for a given weight, the wider the surface area of
the seat, the less the chance of compression.
"I cannot say that sitting on a bicycle seat causes impotence,"
explains Dr. Goldstein, "but I can go on record with supporting data to
show that sitting on a bicycle seat compresses the artery. However, it's
intuitive that if you took a straw and sat on it, a certain percentage of the
time the straw would jump back and be a circular structure. But if you keep
doing this, at some point the straw is going to take on a sort of oval shape [or
flatten]. I can't prove that long-term compression causes impotency, but I kind
of think it does in a very small percentage of cases."
Since this potential cause of impotency does not stem from one traumatic
impact and, in some cases, can remain symptomless for years, it is worrisome for
cyclists who put in many miles. It may be akin to the gradual build up of
cholesterol in blood vessels. Only instead of fatty lipids accumulating on the
artery wall, scar tissue is forming from all the rubbing and compression. Over
time, this may narrow the artery enough to reduce blood flow and cause erection
difficulties.
"If you add the insult of chronic compression to an older man who
has the beginnings of arteriosclerosis, hypertension, a cholesterol and weight
problem, then the straw won't necessarily rebound back as it would in a younger,
healthy man," Dr. Goldstein adds. "I think that's where this fits
in."
An associate professor of urology at the University of Southern
California and the director of The Male Clinic in Santa Monica, California, Dr.
Harin Padma-Nathan says he treats 50 to 100 cases of what he terms
bicycle-related impotency annually.
Typically, the patient is either a roadie who has logged many, many miles on an
unpadded saddle that was set fairly high, or a mountain biker who has been
riding off-road trails aggressively. Both types are also usually quite lean,
meaning they have even less cushioning in their nether regions.
But Dr. Padma-Nathan, who is a former student of Dr. Goldstein's, doesn't
think that saddle compression alone causes impotency. Rather, he views it as
just one of the many factors in an aging man that can combine to sap potency.
"To be diabetic, to smoke cigarettes, to have high blood pressure or
cholesterol puts you at definite risk for erectile dysfunction," he
explains. "But to ride a bicycle? Perhaps it's a risk. It may just
aggravate other factors."
Other urologists agree that there is probably a middle ground.
"I take what Dr. Goldstein says very seriously," says Richard
Lieberman, M.D., a clinical associate professor of surgery (urology) at
Pennsylvania State University, who has treated impotent cyclists at his
Allentown, Pennsylvania-based practice, "but I can think of a lot more
things that are deleterious to one's health that should be outlawed before
bikes. In fact, the overall vascular health of the cyclist may, in a lot of
cases, outweigh some of the local deficit that's created."
In other words, if it wasn't for cycling, and the clean arteries and
powerful hearts it fosters, there might be a lot more impotent older men out
there.
Dr. Padma-Nathan, who rides a stationary bike every day to stay in shape,
actually groaned when he heard the Dr. Goldstein was advocating banning
bicycling. "There's no doubt there's a real issue here," he says,
"but bicycling is an important form of cardiovascular exercise. Rather than
terminate it, I would recommend tailoring this information to your own bicycling
and body type."
In an attempt to clear the controversy, Dr. Goldstein is conducting an
ongoing survey of his cycling patients to pinpoint commonalties of cause. He's
also analyzing thousands of questionnaires from Boston-area cycling and running
clubs in an attempt to compare incidents of impotency between sports. We'll let
you know the results as soon as they're compiled. In the meantime, there are a
number of things you should keep in mind to protect your potency:
~
Penile numbness and excessive genital shrinkage are
warning signs that there may be too much pressure on your crotch. The nerves in
the perineum are being pinched, which means the artery that feeds the penis is
also being compressed.
~
Make the following changes in your riding style
and/or your positioning on the bike: 1) Make sure your saddle is level, or point
the nose a few degrees downward. 2) Check to see that your legs are not fully
extended at the bottom of the pedal stroke. Your knees should be slightly bent
to support more of your weight. 3) Be wary of spending significant time on aero
bars: they encourage riding on the nose of the saddle. 4) Stand up every 10
minutes or so to encourage blood flow.
~
There are a multitude of anatomic racing saddles on
the market, ranging from ones with a flexible nose to models with a hole in the
middle. Although Dr. Goldstein has not tested these special seats, he's
skeptical of any design that fits between the sit bones. Instead, you may want
to experiment with a wider, more heavily padded brand.
~
Heavier riders may be more at risk of arterial
compression damage because of the greater weight that's placed on the perineum.
If you're in this category, you should consider a wider saddle with extra
padding.
~
When riding a stationary bike, the tendency is to
stay seated and grind against big gears for long periods. Get out of the saddle
as frequently as you would on your regular bike and be certain that it's set up
the same in regards to riding position.
~
When you straddle your bike, make sure the top tube
is three to four inches below your crotch. Consider padding the top tube.
~ Get out of the saddle when riding over railroad
tracks, trail debris, or washboard terrain. Use your legs as shock absorbers.
~
Test-ride a recumbent. Since you're in a reclining
position on a chair-like seat, Dr. Goldstein, Padma-Nathan, and Lieberman all
agree that there's little, if any, chance of compression or impact injury.
As Richard Belmont, the patient who experienced penile numbness on a 200-mile
ride puts it: "The thing that angers me most of all in this is my own
stupidity. I had absolutely no idea I could become impotent by riding a bicycle.
If I had known, I would have ridden smarter. I think a lot of guys out there
need to get that message."
Joe Kita, a former executive
editor of Bicycling, is still riding his bike.
If you've experiences
cycling-related impotence we'd like to hear from you. Write in confidence to:
Ed Pavelka
c/o Bicycling
135 N. 6th St.
Emmaus, PA 18090
