Strategies for Reducing the Impact of Cycling on the Perineum in Healthy Males: Systematic Review and Meta-analysis
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SYSTEMATIC REVIEW
Strategies for Reducing the Impact of Cycling on the Perineum in Healthy Males: Systematic Review and Meta‑analysis Kamil Litwinowicz1 · Marcin Choroszy2 · Anna Wróbel3
© The Author(s) 2020
Abstract Introduction Perineal pressure associated with bicycle riding is the cause of several genitourinary pathologies, most notably Alcock’s syndrome and subsequent perineal numbness. The possible link between cycling-induced perineal numbness and erectile dysfunction makes the development of strategies for perineal protection in bicycle users critical. Objective To assess the effectiveness of strategies for reducing the impact of cycling on the perineum in healthy males. Methods We have conducted a systematic review and a meta-analysis of studies examining various means of reducing the impact of cycling on the perineum under the PRISMA guidelines. Results Out of 2217 screened studies, 22 met our inclusion criteria, and 6 qualified for meta-analysis. The strategies included various designs of saddles, changes in the cycling position, seat shock absorber, shorts with different padding, using the recumbent bike. Using the no-nose saddle and recumbent bike resulted in a significant reduction of perineal pressure and higher penile oxygen pressure compared with a standard saddle. Indirect evidence supports the protective effect of standing on the pedals every few minutes during cycling. More evidence is needed to support—or dismiss—other strategies. Conclusions Current evidence supports the use of no-nose saddles as a mean to reduce the negative impact of cycling on the perineum in healthy males at the cost of worse stability and increase of posterior seat pressure. Standing on the pedals every ten minutes might be an effective and potentially widely applicable strategy. The use of a recumbent bike appears to protect the perineum, but several concerns prevent its widespread use.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40279-020-01363-z) contains supplementary material, which is available to authorized users. * Kamil Litwinowicz [email protected] 1
Department of Medical Biochemistry, Wroclaw Medical University, ul. Chalubińskiego 10, 50‑368 Wroclaw, Poland
2
Department of Microbiology, Wroclaw Medical University, ul. Chalubińskiego 4, 50‑368 Wroclaw, Poland
3
Department of Psychiatry, Wroclaw Medical University, Wybrzeze L. Pasteura 10, 50‑367 Wroclaw, Poland
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Key Points Currently, there is limited evidence regarding the safety of using a no-nose saddle and recumbent bike for perineal protection in healthy male cyclists. More research is needed to develop optimal guidelines regarding standing on the pedals as a strategy for reducing the impact of cycling on the perineum. Using the no-nose saddle, standing on the pedals every few minutes and using the recumbent bike are effective in protecting the perineum while cycling.
1 Introduction Cycling is one of the most
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