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Thursday, Sep. 13, 2012

Male cyclists getting the word on ED

Awareness grows in Japan that hard-core riders could be at risk

Staff writer

A warning to hard-core male cyclists: Pain in the perineal area while riding could mean trouble for your sex life.

News photo
Tempting fate?: A man rides a bicycle on a busy street in Minato Ward, Tokyo, last year. YOSHIAKI MIURA

Bicycles for serious riders have hard and skinny saddles, and the pressure point is the perineal area, or the part of the body between the genitalia and anus. The area is home to erection-related nerves and blood flow, and excess pressure could damage them, according to the Japanese Society of Sexual Medicine.

A causal link between riding a bicycle and suffering erectile dysfunction, or ED, suddenly drew the spotlight in Japan when the Japanese Society of Sexual Medicine included it in the 2012 version of the ED Clinical Practice Guideline.

Unfortunately, it remains unclear how much cycling is too much.

Some experts say finding a sitting position, as professional cyclists do, that does not put pressure on the perineal area is sufficient to protect riders from ED. Meanwhile, there has been a boom in Japan of amateur cyclists who want to cycle fast and long but are ignorant of the ED risk.

"We have seen a rise in the number of young cyclists saying they have difficulty getting an erection. That is indicative of bicycle ED," said Masayuki Furuichi, a specialist in ED treatment at the Shibuya 3-Chome Clinic in Tokyo.

He said an increasing number of his patients are cycling enthusiasts and they ask him if they should continue riding, meaning that awareness among cyclists has increased due to media reports on the subject.

At the same time, when it comes to middle-aged and elderly men who are serious cyclists, it is difficult to tell if ED is caused by cycling or other conditions, such as hypertension, he said.

Japanese, especially those living in the Tokyo metropolitan area, have gravitated toward the easy and inexpensive exercise method in the past few years. The widespread disruption of transportation after the March 11 quake last year fueled the boom as more people have been opting to commute by bicycle.

The number of people registered with the Japan Cycling Federation reached 6,321 as of March, up from 6,059 a year earlier. Before then it had been rising only gradually from 5,529 in 2001. The registration is required for cyclists to participate in the Olympics and other world-class competitions.

Cyclists and urologists alike outside Japan may find it strange that the correlation of cycling and erectile dysfunction wasn't included in the ED Clinical Practice Guideline until this year.

This year's version of the guide, updated for the first time in five years, states that "hours of riding on bicycles has a clear correlation with ED."

An epidemiologic survey in 2003 in the U.S. yielded a statistically significant result showing that the number of hours riding a bicycle has a correlation with propensity of ED. No such study has ever been conducted in Japan.

"There are not many reports on bicycle ED in Japan, but there have been many papers (overseas) on it, and thus we decided to include" the description of bicycle ED, said Koichi Nagao, a urology professor at Toho University and the vice chairman of the Japanese Society of Sexual Medicine.

In the February 2003 U.S. study conducted by a team led by Dr. Irwin Goldstein, 1,709 men in their 40s to 70s chosen at random were divided between "sport cyclists," who cycle three hours or more a week, and "moderate cyclists," who cycle less than three hours a week, according to the website of the Boston University School of Medicine, Sexual Medicine.

The study, dubbed the Massachusetts Male Aging Study, showed sport cyclists are more likely to develop ED than other men. Meanwhile, moderate cyclists are less likely to develop ED than men who are not physically active.

"At least three hours of cycling per week was more likely to cause artery blockage and long-term damage," Goldstein said in the study report.

In conclusion, he said, "Most men can take advantage of the many benefits of moderate bicycle riding without worrying that it will lead to ED. Before they begin to ride, however, they should be aware of the need for a properly fitting bicycle and comfortable saddle as well as the potential risks to sexual health presented by long-distance cycling."

One way to prevent ED is to use noseless saddles, which have no front part and thus does not pressure the perineal area.

ED specialist Furuichi commutes to work by bicycle — a 30- to 40-minute trip each way — and has done triathlons. He uses a noseless saddle, but does not like it much.

"I have to stand up to go as fast as I do when sitting on a saddle with a nose. I bear my weight on my arms and they get tired," he said. "Professional cyclists would not be able to cycle stably without a nose on a saddle."

Noseless saddles are not sold widely because there is little demand — few people like them. Kashimax, which make saddles in Japan and China, does not make no-nose saddles, its spokesman said. Bridgestone Cycle Co. and Panasonic Cycle Technology Co. do not make or sell bicycles with noseless saddles, their spokesmen said.

The Tokyu Hands store in Shibuya, Tokyo, offers one made by Ergo — The Seat, an Australian saddle maker, for ¥4,179. A clerk said sales have been rising, though not dramatically.

There are also pants with thick and soft pads designed to help protect the perineal area. Furuichi recommends them but said just wearing a pair isn't enough.

Kashimax President Eijiro Kashima said professional bicycle racers know the risk and arrange their sitting position to the millimeter to reduce the pressure on their perineal area. Also, Furuichi has made inquiries to professional cyclists, who say they don't suffer from ED.

"Bicycle shops should educate their customers when they buy a bike," Kashima said.

There are saddles with a gap in the front end to mitigate pressure on the rider's perineal area, but if the nose is thin, the part surrounding the hole is still a problem, so in the end finding a comfortable seated position or using a noseless saddle is the best way to prevent ED, Furuichi said.

The cure for bicycle ED is the same as other types of erectile dysfunction.

"There is no procedure to fix damaged nerves or blood flow. You have to wait until they heal themselves," Furuichi said.

A study in the U.S. found that police officers who patrol on bicycles experienced better erectile function six months after switching to a noseless saddle.

Furuichi, meanwhile, said it is hard to tell how long a patient will have to wait until damaged nerves or blood flow heal on their own.

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