by James Parker, MD,  co-founder of Cruzbike, Inc.  Dr. Parker is a radiologist (a specialist in the imaging of human anatomy and disease conditions). 

Updated:  14 September 2026

Introduction

If you’ve ever wondered if you’re doing permanent damage to your private parts when cycling, you’re not crazy. Your concerns are valid. As a physician and avid cyclist, I’ve seen firsthand how standard bicycle saddles harm riders. I’ve concluded that the best way to avoid Bicycle Saddle Diseases is to eliminate the saddle entirely; because for most of us, tweaking it—like adding cutouts—doesn’t fix the core issue. 

The problem isn’t the saddle’s shape; it’s the body’s position atop it.

This paper explores bicycle saddle diseases (BSDs)- health risks tied to perineal trauma from standard bicycle saddles. I’ll detail these conditions, backed by science, and make the argument that saddle-free recumbent bikes make cycling available to a much larger subset of the population, not just the “resilient few” (a term I will define later).  Another article will cover head, neck, and shoulder injuries from standard bikes’ high center-of-mass, head-forward stance. For now, let’s focus on what’s below the waist—and why, for most of us, the saddle must go.

What is a bicycle saddle disease?

Bicycle saddle diseases (BSDs) are chronic or acute injuries or illnesses caused by the accumulation of pressure and trauma to the perineum directly related to the use of a bicycle saddle.

For men, bicycle saddle diseases include:

• erectile dysfunction
• urethral strictures
• infertility
• prostatitis
• prostate cancer

For women, bicycle saddle diseases include:

• vulvar numbness
• vulvar pain
• labial fibrosis
• Urinary Tract Infections (UTIs)

Both men and women are subject to perineal folliculitis (inflammation of pubic hair follicles), furuncles (aka saddle sores), and arterial endofibrosis (scarring and stiffening of important arteries).

Cycling has wonderful cardiovascular and mental health benefits, but those shouldn't come, and don't have to come, with the risk of a bicycle saddle disease.

The problem with bicycle saddles

A large portion of the rider’s weight is placed on the bicycle saddle, compressing important structures in the soft fleshy part of the pelvis called the perineum. In men, the parts compressed include the prostate, urethra, and the pudendal nerves and arteries supplying the penis. In women, the saddle may cause vulvar trauma and compression of the pudendal arteries and nerves supplying the vagina and clitoris, with resulting genital numbness, pain, labial fibrosis, and subcutaneous perineal nodules. The saddle does not just compress, but also causes friction and repetitive trauma, as anyone who has ridden over rough roads or hit an unexpected pothole knows.

The heavier you are, the more pressure is exerted on the perineum when you sit on a saddle. Pressure is defined as the force per unit area. The heavier the rider, the more weight (force) is applied to the perineum. The smaller the surface area of the saddle, the higher the pressure for any given weight. Saddles with cutout designs may actually produce higher peak pressure on the perineum because the weight-bearing surface area is smaller. A University of North Carolina study showed “ergonomic” saddles failed to prevent penile blood flow drops in men aged 20-50 [1]. 

Don't be squeamish. Study the images below carefully if you want to understand why the saddle should go the way of the lawn dart.

First is an image of the male perineum seen from below with the skin peeled away to reveal the delicate arteries and nerves, with an overlay of a bicycle saddle (in gray) with a "cutout" which is supposed to lessen compression. The cutout may actually make compression on certain nerves worse by forming edges with higher pressure. Take note of the thin branching yellow structures. Those are the nerves that may die from repeated trauma and ischemia.

Below, the MRI image on the left shows what the vessels in the perineum, near the base of the penis, normally look like (the green arrows are pointing to the vessels, which appear as white circles and ovals). Now look at those vessels on the right (red arrows). They are compressed (flattened) by the saddle.[3] You can't see the nerves on the MRI because they are too small, but they run next to the arteries and veins. Every second that a cyclist spends on a bicycle saddle is time spent compressing vital nerves and blood vessels that supply the sex organs.

The MRI shows how the vessels are physically compressed by the saddle [3]. Also note that the thick layer of fat between the saddle and the penile vessels does not prevent the compression because the pressure is simply transmitted through the fat. This explains why padded shorts, which may reduce friction to the skin, do not prevent compression of the vessels and nerves supplying the genitals in men or women.
A different study measuring oxygen levels in the penis found a remarkable 72.6% drop after just a few minutes on the saddle [1,2]. It’s also important to note that this does NOT happen when riding on a recumbent bicycle [4]. Hypoxia and ischemia to the penis is a problem limited to standard bicycles, when riding in either an upright or aerodynamic tucked position.

Understanding Sampling Bias

Someone reading this may get upset and use Google or ChatGPT to find a study that says cycling does not cause, for example, erectile dysfunction (ED). They may find a study such as the 2020 study: Cycling and men’s health: A worldwide survey in association with the Global Cycling Network [5]. The problem with this study, and many others like it, is called "sampling bias" which is a type of selection bias.

Here’s how studies sponsored by the cycling industry work: they survey existing cyclists that they find through cycling clubs, subscribers to cycling magazines, or followers of cycling social media channels. The ask those riders if they have erectile dysfunction (ED). When the results are tallied up, they often find that the survey respondents rate of ED is no higher than non-cyclists. This selection bias may apply to many of the other bicycle saddle diseases (BSDs), not just ED.

To understand selection bias, let's go through a thought experiment.

Understanding Sampling Bias: The Purple-Nose Thought Experiment

Now imagine for a moment that kayaking caused the nose to turn painfully itchy and purple for 24-hours in 70% of the adult population (of course it does not but just pretend for now that it does). Also pretend that 5% of the adult population gets the same purple-nose attack for no known reason. 

If you are one of those individuals whose nose gets bright purple and painfully itchy after every time you went kayaking, do you think that you would join a kayaking club, subscribe to a kayaking magazine, or follow a YouTube kayaking channel? Of course not! You would stop kayaking and find some other recreational activity with which to occupy your time. Therefore, if the kayak industry were to survey kayak club members, they would find close to NONE of the survey respondents reported purple itchy noses after kayaking... because all the people that get purple itchy noses from kayaking choose not to kayak! The industry results don't reflect reality since their sample population doesn't include any of the purple itchy nose folks. So, even if it is widely known that 70% of all people get purple itchy noses from kayaking, the kayak industry could say, "You are being an alarmist. We surveyed 500 kayak club members and none of them get purple itchy noses from kayaking."

This kayak-industry “research” might even find that bouts of painful purple noses were significantly LESS common in kayakers (0% purple noses) when compared to the general population (5% purple noses), and these results might encourage some kayaking enthusiasts to claim that kayaking PREVENTS purple-nose attacks… even though we know that the opposite is true. This is essentially how the cycling industry gaslights people into believing that cycling on a standard bike is healthy and prevents ED, prostate cancer, etc.

Understanding Sampling Bias: The Real-World Peanut Festival Scenario

Here's a final example of selection bias using a real-world scenario. Approximately 1.5% of the population is allergic to peanuts; if they eat a peanut or breathe peanut dust, they may become very ill or die.
Approximately 200,000 people visit the annual National Peanut Festival in Dothan, Alabama, which features every variety of peanut product imaginable. If peanut festival visitors were a random sample of the population, we would expect about 3,000 allergic reactions to occur each year at the Dothan festival.
But that’s not what happens. There are few or no serious allergic reactions because people with serious peanut allergies don’t go to peanut festivals.

What if the peanut industry surveyed attendees at the peanut festival and determined that peanut consumption is safe for everyone? They would be denounced as unethical and irresponsible.

Many cyclists blithely accept cycling industry sponsored survey studies because they do not understand selection bias and they don’t want to believe that the activity they love could be causing permanent injuries.

For the most part, survey studies on ED and cycling should be disregarded. They do not refute strong evidence that cycling causes erectile dysfunction and other BSDs.

Who are the resilient few?

I believe, based on reading scores of articles about BSDs, that there is a subset of men and women (about 20-30% of the population) who are endowed with anatomy that is protective of the delicate arteries and nerves in the perineum. Perhaps their nerves run inside a protective bony groove or they have an extra layer of protective fascia. These are the hardy people who lead cycling clubs, compete in amateur and professional bicycle races, and swear that they never have ED or genital pain. I call them the “Resilient-Few”. They are also the ones who fiercely defend their chosen sport on social media and are most likely to respond to surveys about erectile dysfunction. For the rest of us “normal” people who lack their special anatomy, padded shorts, saddles designed with cutouts, and proper-bike-fit are not enough to overcome the fact that our perineums were not built to support our body weight.

If you are a member of the Resilient-Few, congratulations. Keep reading and see what may happen to the rest of us who aren’t as fortunate.

Bicycle Saddle Diseases: Erectile dysfunction

Erectile dysfunction (ED) may have a devastating effect on a man's quality of life. But how do we know that cycling causes ED? The proper scientific method to determine if cycling causes ED would be to perform a randomized controlled trial where a random selection of men are randomly assigned either to bicycle regularly or do another activity (e.g. jogging) and then after a designated period of time, the ED rates before and after exposure to these activities are compared. As simple as this would be to conduct, it has never been done. We all learned in high school that correlation of two observed phenomenon does not mean one causes the other. For example, ice cream consumption and shark attacks are well correlated, but eating ice cream does not cause shark attacks. The shark-attack-ice-cream correlation is related to the confounding variable of warm weather.

Then, how do we determine if a relationship (e.g. cycling and ED) is mere correlation, or causal?

In 1965, Sir Austin Bradford Hill proposed nine criteria to help determine if one thing causes another [6].

The Bradford Hill Criteria are:

1. Strength of Association: A strong association (e.g., a high relative risk or odds ratio) is more likely to be causal than a weak association, as strong effects are less likely to be explained by bias or confounding.
2. Consistency: The association is observed consistently across different studies, populations, and circumstances. Replicability strengthens the case for causation.
3. Specificity: Causality is more likely if a specific exposure is associated with a specific outcome rather than multiple outcomes.
4. Temporality: The exposure must precede the outcome. This is the only criterion that is universally considered essential for establishing causality.
5. Biological Gradient: A dose-response relationship supports causation; as the dose of exposure increases, the risk of the outcome also increases.
6. Plausibility: The association should be biologically plausible, based on existing knowledge of mechanisms or theories.
7. Coherence: The association should not conflict with the current understanding of the natural history and biology of the disease.
8. Experiment: Evidence from experiments, such as controlled studies or interventions, strengthens the argument for causality.
9. Analogy: If a similar relationship has been demonstrated with another exposure-outcome pair, it supports causation (e.g., the similarity between smoking and lung cancer compared to second-hand smoke exposure and lung cancer).
   

Now let's apply The Bradford Hill Criteria to what we know about cycling and erectile dysfunction:

1. Strength of Association

A 2021 meta-analysis involving a systematic review of 843 studies examining cycling as a cause for ED found an odds ratio of 2.00 after controlling for age and comorbidities [7]. Cycling DOUBLES the odds of having ED. That's a strong association.

2. Consistency

The association of ED and bicycle saddles has been reported in hundreds of articles for many decades. If we consider horse saddles (which also place at least some of the rider’s weight on the perineum), we can extend that to millennia. Hippocrates, the father of modern medicine, observed that horseback-riding caused ED. He said the following about men who spent a lot of time in the saddle: "the constant jolting on their horses unfits them for intercourse."[8] That was 2500 years ago. That's consistency.

3 , 4, and 5. Specificity, temporality, and dose-response

Specificity measures whether an exposure is linked to a specific outcome, rather than a wide variety of unrelated effects.  In this case, ED is not the only outcome. As we will explore later, other outcomes, such as prostate cancer and urethral strictures, are linked to the bicycle saddle through similar mechanisms. Many causal relationships lack specificity (e.g., smoking and multiple diseases), so low specificity doesn’t negate causality, especially when the other conditions are plausibly related to the same injury.

Temporality measures the relationship between exposure and outcome over time. Many studies note that the ED occurs immediately AFTER the cycling exposure, and that longer rides (higher dose) are associated more strongly with ED. 

Dose-response (biological gradient) is probably the most important of all the criteria.  If larger/longer exposures are more frequently linked to the outcome, then the relationship is most likely causal, not just correlation. We clearly see this in the studies on cycling and ED.

6, 7, and 8. Plausibility, Coherence, and Experiment

A clear "yes" to all of these. Just look at the anatomy relative to the saddle in the above images.  Compression, repetitive trauma, and ischemia (decreased blood flow) are all known causes of permanent tissue damage and loss of function. Laboratory experiments with oxygen sensors confirm a rapid and dramatic drop in perfusion of the penis when sitting on a bicycle saddle.[1] In a 2002 study of police officers assigned to bicycle patrol duty, 91% complained of genital numbness, and they had significantly fewer nocturnal erections than officers not assigned to bicycle duty [9]. This study is especially important because it does not have an obvious selection bias. The subjects are random patrol officers, not self-selected cycling enthusiasts.

9. Analogy

Workers who use a jackhammer may get hand-arm vibration syndrome (HAVS). HAVS may cause loss of dexterity and permanently damage the nerves, blood vessels, and muscles in the hands and arms.

After applying the Bradford Hill Criteria, we can say without a doubt that cycling a lot may cause ED, with at least a 200% increased risk compared to non-cyclists. I say “at least” because even the studies that show a strong correlation between cycling and ED are affected by sampling bias, which would tend to grossly underestimate the true relative risk.

Bicycle Saddle Diseases: Prostatitis and Prostate Cancer

The same repetitive injury and ischemia that causes ED may also cause prostatitis (inflammation of the prostate) and prostate cancer.

First, let's take a look at the location of the prostate relative to the bicycle saddle, and see if injury to the prostate is plausible.

The prostate and urethra sit in the middle of the perineum, just above the center of the bicycle saddle. It is not surprising that saddle pressure and shocks are going to be transmitted to the prostate, where they may cause inflammation.

What about PSA?

Before we go further I should deal with prostate-specific antigen (PSA), because it comes up every time this subject does, and because the evidence on it is genuinely equivocal.

PSA is a protein the prostate releases into the blood when it is inflamed, injured, or cancerous. The obvious question is whether sitting on a saddle squeezes some out. Some studies say yes and some say no [10-13], and the disagreement is mostly about who was tested.

Most of this research was done on young men. The systematic review usually cited to show that cycling has no effect on PSA pooled eight studies [11]. Only two of them were restricted to men over 50;  162 men out of 912. The rest had average ages of 22, 24, 27, 35 and 40. Those are men who would never have a PSA test ordered in the first place, and whose baseline readings are so low that a proportional change probably cannot be detected.

In 129 men aged 50 to 71, a single recreational ride raised total PSA by 9.5%, and the number reading above the 4.0 threshold went from two to six [10]. A randomized study of 101 men aged 20 to 80 found a rise of 8.8% that was statistically significant in the men over 50 and absent in the men under 50 [13]. Against that, a study of 33 men aged 50 to 74 found no significant change [11] — though it drew blood a full hour after the ride, by which time a transient rise would have partly cleared.

Until someone conducts a properly designed randomized controlled study looking at PSA elevation or any of these prostate-related issues, we will have to approach the question keeping in mind the Bradford Hill Criteria for causation.

Applying the Bradford Hill Criteria to what we know about cycling and prostatitis and prostate cancer:

Strength of Association

The best study on the subject found that cycling more than a few hours per week is strongly associated with increased odds of prostate cancer in men over 50. These results were published in the Journal of Men’s Health in 2014. The name of the study: An observational study of erectile dysfunction, infertility, and prostate cancer in regular cyclists: Cycling for Health UK; which I will call the CHUK study for short. In this study, the questionnaire was distributed by the cycling industry's own magazines and governing bodies — Cycling Weekly, Cycling Fitness, the CTC, British Cycling and Sky Ride — to their members, subscribers and readers. Over 5,000 male cyclists completed it [14]. The 2,027 men over 50 were divided into four groups based on how many hours per week they rode their bike. Thirty-six men reported a physician-diagnosed prostate cancer. Here is how they fell across the four groups, as the authors published them, adjusted for age, smoking, body mass index, hypertension, alcohol intake, and other physical activities. p-Trend = 0.025.

Hours per week	#PCa / # of men	odds ratio (OR) of PCa* (95% CI)	prevalence % PCa
0 to 3.75	3 / 511	1.0 (control)	0.6%
3.75 - 5.75	7 / 449	2.94 (0.74 - 11.64)	1.6%
5.76 - 8.5	9 / 569	2.89 )0.76 - 10.96)	1.6%
>8.5	17 / 498	6.14 (1.73 - 21.76)	3.4%

Read honestly, this table says three things. The two middle groups have intervals crossing 1.0 — their point estimates sit near three, but the data are also compatible with no effect, and I won't pretend otherwise. The highest-volume group stands on its own: 6.1 times the odds, interval 1.7 to 21.8. And across all four groups the authors' test for trend — the formal test for a dose-response relationship — is significant after adjustment: p = 0.025.

That trend test is the number that carries the argument, because dose-response is exactly the Bradford Hill criterion under discussion, and it is their own adjusted analysis in their own journal.

Why would the CHUK study reveal a strong association between cycling and prostate cancer, but not cycling and ED? Because prostate cancer develops slowly, silently, and without any symptoms. Even the resilient few who seem to be immune to the ED complications of cycling are not immune to the increased risk of prostate cancer.

But aren't high-volume cyclists just getting diagnosed more?

That’s a fair question and it deserves a straight answer. Prostate cancer is unusual among cancers in that an enormous reservoir of it sits undetected in the population. Autopsy studies find it in a large fraction of men over 50 who died of something else entirely and never knew they had it. When that much disease is sitting there waiting to be found, the number of men diagnosed depends heavily on how many men get looked at.

So: if men who ride nine hours a week are more health-conscious, or see doctors more often, they would get more PSA tests, more referrals, and more biopsies — and they would accumulate more diagnoses without necessarily carrying any more disease. The dose-response curve above would be a curve of medical attention, not of cancer.

Fortunately, the CHUK authors anticipated this and tested for it. They examined whether men who cycled more also consulted their doctors more often. They did not. Forty-eight percent of participants had seen their physician once or twice in the previous year, with no statistically significant difference between the four cycling-volume groups (p = 0.52) [14]. The authors concluded that higher activity levels were not associated with increased health-seeking behavior.

Coherence: Does the association of cycling and prostate cancer match our current understanding of the natural history and biology of the disease?

Yes. It is widely known that chronic injury and the associated inflammation can potentially contribute to the development of cancer [15]. This connection is based on biological mechanisms where persistent injury or irritation leads to a chronic inflammatory state, which in turn creates an environment conducive to cancer development. Here's how this process might work.

Repeated tissue damage from injury can lead to ongoing inflammation. Chronic inflammation involves the release of inflammatory cytokines, growth factors, and reactive oxygen species (ROS), which can cause DNA damage and promote cellular mutations. To repair injured tissue, the body induces increased cellular proliferation. With more frequent cell division, there is a higher chance of mutations and, eventually, cancer. Persistent injury also results in fibrosis (scar formation), altering the tissue microenvironment. These changes can disrupt normal cellular signaling and promote a tumorigenic environment. And finally, chronic injury can lead to epigenetic modifications, such as DNA methylation and histone modification, which may silence tumor suppressor genes or activate oncogenes [15-19].

Analogy: Examples of other cancers linked to chronic injury

• Esophageal Cancer: Chronic injury from gastroesophageal reflux disease (GERD) can lead to Barrett's esophagus, a precursor to esophageal adenocarcinoma.
• Liver Cancer: Repeated liver injury due to hepatitis or chronic alcohol use can cause cirrhosis, which increases the risk of hepatocellular carcinoma.
• Skin Cancer: Chronic exposure to ultraviolet radiation causes repeated skin injury, leading to mutations that may result in melanoma or squamous cell carcinoma.
• Bladder Cancer: Persistent irritation from schistosomiasis infection or chronic catheter use has been associated with an increased risk of bladder cancer.
  

How did the cycling world respond to the 2014 CHUK study? What is the counter-argument against cycling causing prostate cancer?

The CHUK study's implication that cycling may cause prostate cancer made headlines and shocked cyclists around the world. Rather than prompting the randomized controlled trial the question deserved, the cycling world answered six years later with another survey — this one recruiting from the audience of the Global Cycling Network's YouTube channel.

The GCN study was published in the Journal of Clinical Urology in 2020, and it reported no association between cycling and prostate cancer. Before you take comfort in that, read the paper rather than the headline. Four things in it are worth knowing.

One: the study could not have found what it reports not finding.

Prostate cancer is a disease of older men. The GCN survey collected 8,074 responses, and 4,531 of them — 55% — were from men under 35. Only 726 men, 9% of the sample, were 55 or older. Compare that to CHUK, which had 2,027 men over 50.

Now look at where the cancers actually were. Of the 47 prostate cancer diagnoses in the entire study, 36 were in those 726 older men. One case turned up among 1,740 men aged 18 to 24. Three among 2,654 men aged 25 to 34.

So when the authors tested cycling volume against prostate cancer, they tested it across the whole cohort — thousands of young men who essentially cannot get the disease, pooled together with the few hundred who can. A dose-response effect in older men would be invisible in that arithmetic. They did not find an association because the study was not built to find one, and they never once broke the older men out by cycling volume, which is the single analysis that would have answered CHUK.

A study that cannot detect an effect is not evidence that the effect is absent.

Two: they report no effect sizes and no confidence intervals. Anywhere.

The entire statistical result of the GCN study is one small figure listing each exposure, the word "Yes" or "No" under the heading Correlation, and a p-value. There is not a single odds ratio in the paper. Not one confidence interval.

You cannot judge a negative finding without knowing how large an effect the study could have ruled out, and that requires an effect estimate with an interval around it. CHUK published theirs — every odds ratio in that paper comes with 95% confidence limits, which is precisely why you and I can argue about how strong its findings are. The GCN paper gives its readers nothing to check.

It's also worth noting what that figure does show. Before adjustment, years spent cycling was significantly associated with prostate cancer, and with erectile dysfunction. Both associations disappear after what the authors describe only as "regression modelling with risk factors" — with no model specified, no covariates listed, and no output shown. Adjusting for age is reasonable. Doing it invisibly is not.

Three: one of their tables is impossible.

The GCN authors used the Sexual Health Inventory for Men, a validated questionnaire that sorts men into five categories. Here is what they report:

• No erectile dysfunction: 7,159 men
• Mild erectile dysfunction: 0 men
• Mild-to-moderate erectile dysfunction: 0 men
• Moderate erectile dysfunction: 1,066 men
• Severe erectile dysfunction: 35 men

Zero. In a sample of 8,074, not one man landed in either of the two mildest categories of dysfunction — the categories that in every normal population are the most commonly occupied. Then 1,066 men appear in "moderate."

That is not a result. It is a scoring error, and it means the erectile dysfunction severity data in this paper cannot be interpreted at all.

Four: an author works for the Global Cycling Network, and the paper declares no conflict of interest.

The paper's conflict-of-interests statement reads that the “authors declare that there is no conflict of interests."

The last-listed author's affiliation, printed on the first page, is "Global Cycling Network, UK." The contributorship statement says he prepared the video and collected the data. So, the cycling media channel whose subscribers made up the entire data sample, also supplied an author, who built the recruitment instrument and gathered the responses. That’s a conflict of interest. I have a business interest in the answer to the question (does high-volume cycling increase the risk of prostate cancer?) I've told you so on this page. They had one too.

And then there's the sampling.

Everything in my purple-nose argument applies to this study with full force. The GCN video was viewed 619,105 times and produced 8,074 completed questionnaires — a 1.3% response rate, drawn entirely from people who had chosen to subscribe to a cycling channel and then chose to answer. Men who stopped riding because it hurt them are not in that sample. They unsubscribed years ago.

You can watch the authors walk right past this. They note that 14.5% of their cyclists reported ever having erectile dysfunction, and that population studies find 52% of men aged 40 to 70 have it. A rate less than a third of the general population, in a survey of men recruited from a cycling channel, and the paper treats it as reassurance rather than as a question about who filled in the form.

In summary. The GCN study is not evidence that cycling is safe for the prostate. It is a survey of mostly young men, recruited from a cycling channel by one of that channel's own employees, reporting no effect sizes, containing at least one impossible table, and never performing the one analysis that would have tested CHUK's finding. It does not refute the evidence that high-volume cycling raises prostate cancer risk in men over 50. It cannot even address it.

But I read that cycling reduces the risk of prostate cancer? 

Not quite. What the research shows is that exercise appears to change the course of the disease rather than prevent it. The two largest studies of physical activity and prostate cancer incidence — one covering 1.44 million adults, the other following 47,620 men for fourteen years — found no reduction in the rate of diagnosis at all [22, 23]. Both found a slight increase, which their authors attribute to active men being screened more often.

What activity does appear to do is reduce advanced and fatal disease. Men over 65 doing three or more hours a week of vigorous exercise had substantially lower rates of advanced and fatal prostate cancer [23], and men already diagnosed with prostate cancer had markedly lower mortality from it [20,21], and lower rates of progression [24].

That is worth having, and nothing in this article argues against it. Vigorous exercise for three hours a week is good for you. The question is only what you are sitting on while you get it — and a recumbent gives you every one of those hours without loading your perineum. Also keep in mind that those hours on the saddle aren't always done on the road. Indoor cycling (e.g. Zwift and Peleton) are popular activities that also compress the perineum and may carry the same risks. 

Before we move on to the next BSD, I’m going to make one more point from that very important CHUK study. If you pool the data, combining all the men who ride over 3.75 hours per week, you get this (unadjusted) chart:

Hours per week	#PCa / # of men	odds ratio (OR) of PCa* (95% CI)	prevalence % PCa
0 to 3.75	3 / 511	1.0 (control)	0.6%
> 3.75	33 / 1516	3.77 (1.2 - 19.3)	2.2%

 

This crude pooled comparison yields a Fisher exact, two-sided p = 0.019. This was not published in the original paper, but the math is easy to do. It shows an odds ratio of 3.77 for prostate cancer in the men who ride more than 3.75 hours/week compared to men who ride less than that, with a 95% confidence interval from 1.2 to 19.3.

Bicycle Saddle Diseases: Urethral Strictures

I know a urologist who says he commonly sees urethral strictures in his male cycling patients. A urethral stricture is an area of partial blockage in the tube that carries urine from the bladder to the end of the penis. Strictures may occur from years of chronic injury, or from one sudden accident where the perineum slams into the saddle, which may occur, for example, if the chain breaks at just the moment the rider is standing on the pedal trying to get started after a stop. Looking closely at the image below, it is obvious why the urethra gets injured by the saddle. It sits just above it, with very little protection. Urethral strictures can impact your quality of life, slow down your urinary stream, and have other genitourinary symptoms. Sometimes they require surgery or stent placement.

A 2018 study published in the Journal of Urology reported that active cyclists' odds of having a urethral stricture were 2.5x the odds in swimmers and runners [25]. I believe that the increased risk of urethral stricture from cycling is actually much higher than this study reveals, due to the effects of selection bias, which we have discussed previously. Doesn't it make sense that men who injured their urethras on a bike ten years ago, would have moved on to other sports, like swimming or running? 

Bicycle Saddle Diseases: Arterial Endofibrosis

Too much riding in the aero-tuck position (leaning forward so that the upper body is parallel to the ground) on a standard bike saddle may damage large arteries in the pelvis in a disease process called arterial endofibrosis.

The human body was not designed for prolonged exertion of the lower extremities while the hips are severely flexed.

This position may cause a fold or kink in the external iliac artery, with resulting endofibrosis (thickening and scar formation of the inner wall of the artery).

This typically presents with pain, cramping, or fatigue in the thigh or calf muscles during or after an intense workout. It may also result in numbness or tingling in the leg or foot; or coolness or discoloration during or after exercise. If symptoms are ignored and the damage continues, this may result in permanent arterial narrowing and may require surgical intervention [26-32].

Humans evolved to produce maximal power while walking or running with the hips reaching full extension, a position much more closely approximated when cycling in the recumbent position or when standing up out-of-the-saddle on a standard bike.

Bicycle Saddle Diseases: Infertility, Low Sperm Quality

Numerous studies [33-38] demonstrate that intense or prolonged cycling (>5 hours/week) consistently impairs sperm parameters (e.g., concentration, motility, morphology) in men, with pooled or adjusted risks approximately 1.5–2x higher for low concentration/motility compared to non-cyclists or sedentary controls. The more time spent cycling, both in duration and distance, the greater the decline in sperm quality.

This may not be an issue for older cyclists, or recreational cyclists, but it is another BSD that may be important if you want to cycle a lot and be fertile. 

Bicycle Saddle Diseases: Vulvar pain, numbness, female sexual dysfunction, and UTIs

As bad as the men have it, BSDs in women may be worse. Take a look at where the saddle is rubbing and applying pressure on the female perineum. It’s basically the entire vulva, including the clitoris, urethral opening, labia minor, labia majora, and vaginal introitus. There are delicate nerves, arteries, and veins supplying the vulva that are subject to severe compression and damage. The next image shows a cut-away model-view of the female perineum viewed from below, with a saddle with a cutout superimposed.  

In the illustration above, note that the urethra sits between the clitoris and the vagina. Prolonged pressure on the urethra can drive bacteria up the urethra, triggering a urinary tract infection (UTI).  Padded shorts, which block ventilation and trap heat and moisture may increase bacterial levels and contribute to the risk of UTIs [39-44].  Specifically, compared to non-cyclists, both low-intensity and high-intensity cyclists had higher odds (1.4 x)  of reporting a previous UTI.  The low-intensity cyclists had 6.5x the odds of reporting genital numbness and the high-intensity cyclists had 9.1x the odds of reporting genital numbness [39].

A study comparing female cyclists to runners found cyclists reported higher rates of genital pain, tingling, or numbness compared to female runners [45].  Objective sensory testing showed decreased genital sensation measured via elevated vibratory thresholds at multiple sites, including the anterior (front part of the) vagina. This study links prolonged/frequent cycling to pudendal nerve alterations, contributing to numbness and reduced sensation. 
Regarding sexual dysfunction and genital numbness, it's important to understand that no two people have the exact same network of nerves and arteries supplying their genitals. The pattern is as unique as a fingerprint. This is why a specially designed saddle with cutouts may help one person, but actually make the problem worse for someone else.

Bicycle Saddle Diseases: Labial Fibrosis

The next image shows what labial fibrosis and furunculosis may look like when they develop from extensive riding on a standard bicycle. Fibrosis can make the labia hard, bumpy, and painful, sometimes requiring surgical labiectomy in female cyclists.

Studies have found high rates of vulvar pain, vulvar numbness, and sexual dysfunction in surveyed female cyclists. In one survey of female cyclists (average age 48 years), 69% reported genital pain, 58% reported genital numbness, and 54% reported sexual dysfunction [46]. And don’t forget the effects of selection bias. If 69% of female cyclists report genital pain, we can assume the percentage of non-cyclist women who would experience genital pain if they took up cycling would be much higher.

If you want to read more stories about female BSDs, the Bicycling article: "Cycling’s Silent Epidemic" by Gloria Liu, published in 2024. Liu does a good job describing the problem, documenting numerous women with lopsided, painful, and swollen labia from too much time on the bike saddle. But rather than address the root cause (the labia are not designed to be a weight-bearing structure), she promotes de-stigmatizing labiaplasty (surgery to cut away parts of the labia) for female cyclists, and tweaking the saddle (making it wider here, narrower there, etc.). 

While there are some female cyclists who will benefit from a different saddle, it’s worth repeating that the main problem is not the shape of the saddle but rather the position of the rider's vulva above it. 

The most effective solution is also much easier. Ride a recumbent and get the pressure and friction off of the vulva. For more information on women’s BSDs, read Liu’s article and review references 39-44, 46-49.

The Solution: a Healthier, Thrilling Way to Ride

Now you know you are right to be concerned about the health risks from standard bicycle saddles. Avoiding prolonged contact with standard saddles is wise if you want to reduce your risk of pain, injury, and illness. The studies we have just reviewed show that saddle pressure can reduce penile oxygen pressure by approximately 73% in just a few minutes, increase odds of prostate cancer by as much as six-fold in men over 50 who cycle heavily, cause genital pain or numbness in 69% of female cyclists, and double (or more) a man’s odds of getting ED or a urethral stricture.

These aren’t mere discomforts or minor irritations of the private parts; they’re real threats to your health, quality of life, sexual wellness, and longevity.

But there’s a game-changing solution: recumbent bicycles like those from Cruzbike. By shifting to a laid-back riding position, Cruzbike recumbents eliminate perineal pressure entirely, protecting your vital nerves and arteries.  For female cyclists, recumbents place the vulva in a forward-facing, non-weight-bearing position, where ventilation is improved and thick padded shorts aren't needed, thus reducing the risk of a UTI, genital pain/numbness, and labial fibrosis.

For male cyclists, recumbents don't crush the nerves and arteries that allow you to maintain an erection. That's a really big deal for most guys. But so is reducing your risk of urethral strictures, prostatitis, and prostate cancer.

Imagine cycling without the ache of saddle sores or the worry of long-term damage—just pure, exhilarating freedom. Our bikes, the V20c, S40, Q45, and T50, are designed for speed, comfort, and performance, whether you’re tearing through a 200-mile ultracycling race, hauling gear on a cross-continent adventure or just cruising for fun around town.

The front-wheel-drive system offers unmatched efficiency, letting you climb powerfully up hills, and then leave the traditional bike riders behind on the flats and downhills… all while enjoying a clear view of the road and a relaxed posture that spares your neck, shoulders, wrists, and genitals.

My wife, Maria, and I have logged 100,000 miles on these bikes, from mountain races to time-trials to leisurely tours; and our customers have racked up millions more worldwide. They’ve discovered what we have—a cycling experience that’s not just healthier but downright thrilling.

Your concerns about saddle-related health risks are valid. Don’t let them stop you from enjoying cycling’s incredible benefits.

We invite you to experience Cruzbike for yourself. Visit cruzbike.com to explore our models, find a test ride near you, or connect with our community of riders who’ve made the switch. Whether you’re a weekend warrior, a fitness enthusiast, or dreaming of your next big race, Cruzbike opens the door to a new kind of cycling adventure—one that’s safe, comfortable, and undeniably badass. Come ride with us and feel the difference!

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**FURTHER READING**

 

Sommer, F., Goldstein, I., & Korda, J. B. (2010). Bicycle riding and erectile dysfunction: A review. *The Journal of Sexual Medicine, 7*(7), 2346–2358. https://doi.org/10.1111/j.1743-6109.2009.01664.x

 

Huang, V., Munarriz, R., & Goldstein, I. (2005). Bicycle riding and erectile dysfunction: An increase in interest (and concern). *The Journal of Sexual Medicine, 2*(5), 596–604. https://doi.org/10.1111/j.1743-6109.2005.00099.x

 

Goldstein, I., Lurie, A. L., & Lubisich, J. P. (2008). Bicycle riding, perineal trauma, and erectile dysfunction: Data and solutions. *Current Sexual Health Reports, 5*(1), 21–27. https://doi.org/10.1007/s11930-008-0005-x

 

Taylor, J. A., III, Kao, T.-C., Albertsen, P. C., & Shabsigh, R. (2004). Bicycle riding and its relationship to the development of erectile dysfunction. *The Journal of Urology, 172*(3), 1028–1031. https://doi.org/10.1097/01.ju.0000136461.84851.4a

 

Lowe, B. D., Schrader, S. M., & Breitenstein, M. J. (2004). Effect of bicycle saddle designs on the pressure to the perineum of the bicyclist. *Medicine & Science in Sports & Exercise, 36*(6), 1055–1062. https://doi.org/10.1249/01.MSS.0000128248.40501.73

 

Dettori, J. R., Koepsell, T. D., Cummings, P., & Corman, J. M. (2004). Erectile dysfunction after a long-distance cycling event: Associations with bicycle characteristics. *The Journal of Urology, 172*(2), 637–641. https://doi.org/10.1097/01.ju.0000130749.37731.9f

 

Schrader, S. M., Breitenstein, M. J., & Lowe, B. D. (2008). Cutting off the nose to save the penis. *The Journal of Sexual Medicine, 5*(8), 1932–1940. https://doi.org/10.1111/j.1743-6109.2008.00867.x

 

Ramsden, C. E., McDaniel, M. C., Harmon, R. L., Renney, K. M., & Faure, A. (2003). Pudendal nerve entrapment as source of intractable perineal pain. *American Journal of Physical Medicine & Rehabilitation, 82*(6), 479–484. https://doi.org/10.1097/01.PHM.0000069196.15353.7D

 

Leibovitch, I., & Mor, Y. (2005). The vicious cycling: Bicycling related urogenital disorders. *European Urology, 47*(3), 277–287. https://doi.org/10.1016/j.eururo.2004.10.024

 

Lee, A., & Breyer, B. N. (2020, March 11). Bicycle riding: Good or bad for men's health? *Urology Times*. https://www.urologytimes.com/view/bicycle-riding-good-or-bad-mens-health

 

Sperling Prostate Center. (2020). *Is bike riding tough on male pelvic health?* https://sperlingprostatecenter.com/is-bike-riding-tough-on-male-pelvic-health

 

Mellion, M. B. (1991). Common cycling injuries: Management and prevention. *Sports Medicine, 11*(1), 52–70. https://doi.org/10.2165/00007256-199111010-00004

 

Illustrations Credit: Thanks to Olga Kurkina of Poland for the anatomic illustrations that help bring this article to life (olgaillustrates.com)