Cycling and Prostate Health

The prostate gland is a male reproductive gland. It is about the size of a walnut and encircles the urethra at its connection of the bladder. The prostate is a crucial part of the male reproductive system, producing fluid that helps keep semen healthy.

The pudendal nerve is a major pelvic nerve. It provides sensation and motor control of muscles in the genital area and plays a crucial role in sexual function. Damage or irritation of the pudendal nerve can lead to chronic pain in the pelvic area/genitals and can impact sexual function (erectile dysfunction or pain during intercourse).

The distance from the perineal skin (which is on the bicycle seat) to the pudendal nerve and prostate varies by individual. The pudendal nerve lies roughly 1.5 to 2.5 cm beneath the perineal skin (laterally, near the ischial tuberosity) while the prostate sits deeper within the pelvis and is typically 2.5 to 4.5 cm from the surface of the perineum.

This image shows the relative relationship of the prostate, pudental nerve, and dperineal skin (which on on the saddle).

Pudental Nerve Injury and Numbness/sexual dysfunction

Injury to the pudental nerve (with associated sexual dysfunction) results from compression of the nerve between the saddle and pubic bones. There is little hard data on the frequency of this complaint in recreational riders, but even if uncommon it would be considered devastating by many male cyclists. One study prospectively studied a group of cyclists who would be expected to be at greatest risk - a cohort of 463 cyclists participating in one of six different recreational bicycle rides of at least 320 km. With their prolonged saddle time, the incidence of erectile dysfunction was 4.2% at one week and 1.8% one month after the ride.

A review in 2023 noted that 19% of cyclists with a weekly riding distance of more than 400 km commented on erectile dysfunction and 61% had experienced perineal numbness. It was assumed that compression of the pudendal nerve during pedaling, especially with strenuous effort and excessive pressure on the saddle, lead to transient hypoxemia of the nerve. And several studies suggested it was actually excessive pressures in the anterior region of the saddle that were most harmful to the perineal tissue and nerves.

Even though it is uncommon, male rider worries prompted an "intuitive" change in bicycle seat design - a central cut out was added - with the idea the saddle would then put less pressure on the perineum Did it help? While cutout saddles may help some individuals, the evidence is murky and inconclusive. The cutout redistributes pressure and it is easy to understand how it might actually worsen pudental nerve pressure in some. In fact, the endurance study found that saddles with cutouts actually increased the risk of erectile dysfunction. And if the review mentioned above is correct, a noseless saddle might be a better design change - but at the cost of a decrease in stability and increase in posterior seat pressure.

Prostatitis

How about the prostate itself? Can riding lead to injury and inflammation (prostatitis) of this gland and explain the pelvic pain some riders experience when sitting on the saddle? The prostate is much deeper in the pelvis and would be more protected from pressure of the bicycle saddle. And in fact there is no evidence that bicycle riding causes prostatitis, either acute or chronic, in healthy men. (Note: cycling may not cause, but can aggravate, symptoms in men who already have chronic prostatitis/chronic pelvic pain syndrome).

Acute bacterial prostatitis is typically caused by an infection, often from urinary tract bacteria and has not been linked to cycling.

Chronic prostatitis/CPPS, which is more common and not infectious, has a multifactorial cause, including pelvic floor dysfunction, inflammation, and possibly nerve hypersensitivity. Some men with this condition report that cycling worsens their symptoms.

In Summary:

Cycling does not cause, or increase, the odds of, acute prostatitis
Longer saddle times increase the risk of pudental nerve injury.
>Cutouts in saddles do not solve the problem. If you are dealing with perineal discomfort or numbness these suggestions should be considered:
- regularly standing on the pedals.
- a professional bike fit focusing on decreasing the pressure being placed on the front of the saddle - saddle tilt being a key change
- a change in saddle shape to better match the width of the ischial tuberosities (sits bones). This means avoiding the narrow "racing" saddles which sit higher between the ischial bones
- better padding in your bike shorts.
No studies have established cycling as a factor in developing prostatitis - either acute or chronic.

Prostate Cancer

Numerous studies have documented a decrease in cancer risk of 10 - 20 % in physically active individuals, and as much as a 50% decrease for certain selected cancers. A recent study from Sweden focusing on prostate cancer found a 35% decrease in the study subjects who were physically fit. A definite positive for male cyclists.

All questions and suggestions are appreciated and will be answered.

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