Digital three-dimensional modelling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction.

BJU Int. 2007 Jan;99(1):135-40.
Comment in:

• BJU Int. 2007 Oct;100(4):947; author reply 947.

Gemery JM, Nangia AK, Mamourian AC, Reid SK.

Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. john.gemery@hitchcock.org

OBJECTIVE: To digitally model (three-dimensional, 3D) the course of the pudendal arteries relative to the bony pelvis in the adult male, and to identify sites of compression with different bicycle riding positions as a potential cause of penile hypoxia and erectile dysfunction. SUBJECTS AND METHODS: 3D models were made from computed tomography scans of one adult male pelvis (a healthy volunteer) and three bicycle seats. Models were correlated with lateral radiographs of a seated rider to determine potential vascular compression between the bony pelvis and seats at different angles of rider positioning. RESULTS: Pelvis/seat models suggest that the most likely site of compression of the internal pudendal artery is immediately below the pubic symphysis, especially with the rider leaning forward. For an upright rider, the internal pudendal arteries do not appear to be compressed between the seat and the bony pelvis. Leaning partly forward with arms extended, the seat/symphysis areas were reduced to 73 mm(2) with standard seat and 259 mm(2) with a grooved seat. Leaning fully forward, the seat/symphysis areas decreased (no space with standard seat; 51 mm(2) with a grooved seat) and both the ischial tuberosities and the pubic symphysis might be in contact with the seat. CONCLUSION: A grooved seat allows better preservation of the seat/symphysis space than a standard seat, but the rider’s position is more important for preserving the seat-symphysis space (and reducing compression) than is seat design alone. Any factors which influence the seat-symphysis space (including an individual’s anatomy, seat design and rider position) can increase the potential for penile hypoxia and erectile dysfunction/perineal numbness.

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