A Novel Method to Determine the Impact of Different Saddle Designs on Male Cyclists' Perineal Blood Flow

Greater than 60 million American men who ride bicycles are at risk of developing erectile dysfunction due to total perineal artery occlusion. The purpose of this study was to directly measure total perineal artery occlusion in real time among male bicyclists for distinct seat design typologies during a stationary bicycle ride and during a natural bicycle ride to determine general risk of arterial occlusion for any seat and to assess differences between seats. The perineal arteries of 20 healthy men of ages 18 to 64 years were identified by Doppler ultrasonography, and an ultrasonographic operator determined the force associated with total perineal arterial occlusion for each man. Subjects then rode bicycles with 6 distinct seat designs, both on a stationary trainer and in natural conditions, and the force exerted on the perineal arteries was recorded dynamically in real time with a portable device engineered specifically for the study. Arterial occlusion was determined by comparing perineal forces measured during bicycle riding to the occlusion force measured by Doppler ultrasonography. We expressed the duration during which the perineal arteries were completely occluded as a proportion of total ride time, and assessed this proportion as the primary outcome measure. We employed Generalized Estimating Equation (GEE) models to compare the proportion of occlusion time for each seat in natural and stationary conditions. The mean estimate of occlusion time proportion was 0.52 (95% CI, 0.37-0.67) indicating that greater than half the time a bicycle rider is in contact with a typical seat, his perineal arteries are completely occluded. No seat’s mean estimate of occlusion time proportion was less than 0.41. Occlusion time proportion was significantly less for no-nose seats than for nosed seats, but all seats completely occluded the perineal arteries for at least 41% of the duration of a bicycle ride. No current type of seat design presents low risk to riders concerned with the development of erectile dysfunction.