I've recently gotten into bicycling and I love it, but there's one problem. Every time I go for a long ride, my whole pelvis hurts for days. I'm no expert but this can't be good. Can riding around with a little bicycle seat lodged up my ass end up doing any permanent damage to my prostate or anything else? — Vincent J., Scottsdale, AZ
We hear constantly that Americans need to exercise more, and bicycling is a great option. It's low impact, variable resistance, and has great cardiovascular potential. However, the position bicycling puts you in can cause some physical problems in some people, as you've noticed. Although your prostate gland is deep enough in the body to be safe from harm, a commonly reported condition is called "Pudendal Nerve Entrapment."
The pudendal nerve may be the most important nerve in your body. It's involved in sensation of the penis and perineum (also known as "the taint"), and is intimately involved in the process of ejaculation. Sitting on a bicycle seat (leaning forward, to boot) can put a lot of pressure on the pudendal nerve and some of the blood vessels in the area. The theory is that this pressure causes "entrapment" and dysfunction of the nerve. Pudendal nerve entrapment has been implicated in pelvic pain, loss of sensation in the penis, erectile dysfunction, and difficulty ejaculating. Overall a bad scene.
Not all researchers believe this is a real problem. A 2004 study in the Journal of Urology looked at 688 cyclists and found no statistically significant difference in erectile problems in the study group compared to non-cyclists. However, a study of 90 bicycle-riding police officers did show that using a "saddle without a nose" seat design resulted in less penile numbness and pain. Another study showed that riders who used seats with a wider posterior region (distributing weight to the "assbones," or "ischial tuberosities") had fewer physical complaints.
Unfortunately, the data on bicycle riding is not complete. There is a huge body of evidence that indicates that exercise is good for your general and cardiovascular health. If bicycling is your thing, you're probably in more danger from someone driving a car carelessly than you are from your bicycle seat. Get to your bike shop and make sure the machine fits your body, encourages proper posture, and the seat distributes your weight properly (away from your genitalia). A good bicycle mechanic can make this work for you. You'll know the adjustments you've made to your ride are working when the pain goes away.
When exercise ceases to be enjoyable, people naturally give it up. Making a few ergonomic changes to your bicycle will hopefully bring the fun back. For those who can never seem to find a way to ride without pain, my best advice is to find another hobby.
**Remember, don't do anything you read here without first consulting with your own health care provider.**
Dr. Steve is the resident medical expert for the Opie and Anthony and Ron and Fez shows, and the host of his own Sirius XM Radio program, Weird Medicine.