Originally created 02/18/99

Impotence controversy has bicyclists riding uneasy



For years, he was bicycling's version of the hard-working weekend warrior, venturing out Sunday mornings for a huff-and-puff along the coast and a first-hand look at the spectacular scenery right there beyond his own back yard in Palos Verdes, Calif.

Still, with each 30-mile ride came the nagging tingle and numbness in his groin -- troubling symptoms he rationalized away as the devil's due for a middle-aged man pedaling hard to stay in shape.

Soon, however, his problems moved from the bicycle to the bedroom. After his wife made gentle comments about his performance, the 59-year-old professor finally confronted a no-win choice: sex or cycling.

"I was fairly depressed about the whole thing," said the educator, who asked that his name not be used. "I thought, `Here I am, trying to stay healthy, and now I have to deal with this little side effect.' After so many years, bicycling had become an addictive part of my life, and suddenly I was at a point where I had to choose.

"I certainly wasn't going to give up my sex life, but I also sure hated to give up bicycling."

He temporarily quit cycling and consulted a specialist. A year later, with new biking equipment and regular doses of Viagra, he's back at both pastimes with gusto.

The professor is one of a growing number of enthusiasts to experience a medical condition that for years has been secreted away in the closet of the bicycling community -- the possibility that riding a bike can cause sexual impotence in men.

Two years ago, noted Boston urologist Irwin Goldstein shook the cycling world with new -- and immediately challenged -- claims of the sport's ill effects. Regular riding placed undue weight on the arteries and nerves that feed the male reproductive system, he said, restricting critical blood vessels and causing possibly permanent damage.

His conclusions were no-nonsense: More than 100,000 American men had been left permanently impotent from cycling, which Goldstein called the most irrational form of exercise. And the phenomenon troubled more than just cycling's "Tour de France crowd" -- the dedicated habitual road rider -- but affected mountain bikers, stationary bike riders, even young novices.

The trouble, Goldstein said, wasn't so much the perilous support bar on men's bikes as the innocuous seat -- especially those narrow racing saddles with the elongated nose that he claims put dangerous pressure where it was never intended.

Furthermore, the doctor said, there were but two types of cyclists -- those who were already impotent and those who would eventually become so.

Two years later, Goldstein has given little ground.

"Every single day I sit in a chair and I face people who were made impotent, whose only crime in life is that they rode one of these objects -- I won't dignify them any more than that. They're men in their 20s and 30s, and their lives have now been made miserable. They say, `Doctor, it's all in my head. I must not love my wife,' " Goldstein said.

Goldstein's warnings have been both heralded and dismissed across all corners of the bicycling and medical communities. The bicycle seat industry has invested millions designing and manufacturing ergonomically correct saddles that the companies say solve the problem.

But many doctors question whether that's necessary.

"I'm unconvinced that bicycling, for the vast majority of men, is an important cause of impotence or erectile dysfunction," said Dr. Harin Padma-Nathan, director of the Male Clinic in Beverly Hills, Calif.

"Will biking cause impotence for the average cyclist, and does that risk outweigh the sport's cardiovascular benefits?" he asked. "I think the answer is no on both counts."

Nevertheless, some dealers say the issue has already driven newcomers from the sport and has caused advocates to think twice about their pedaling pursuits.

"People are beginning to avoid the sport -- they're saying, `Gee, maybe I should try golf or bowling instead,' " said Alan Goldsmith, owner of Supergo Bike stores of Santa Monica and Fountain Valley, which are among the largest cycling retailers in California.

Goldstein's studies are not the first look at the connection between cycling and impotence. Since 1974, numerous case reports and small published studies worldwide have suggested a relationship between bicycle seats and restricted blood flow to male sexual organs.

But once Goldstein -- a nationally recognized authority on male impotence -- began making such dire predictions, people began to take notice, said Dr. Roger Minkow, a physician, product designer and bicyclist from Petaluma, Calif.

"As a result, most people have come to the conclusion that there is a problem," Minkow said. "But most physicians believe the trouble is mostly pain and numbness and, to some small degree, impotence.

"Goldstein has gone in the other direction, saying all these tens of thousands of men are already impotent. Those high numbers of impotent men -- that's where the controversy lies."

Like so many others, Minkow saw the August 1997 issue of Bicycling magazine detailing the connection between cycling and impotence.

But Minkow, 52, did something about it.

He began drawing up plans for a new type of bicycle seat that would relieve the pressure on nerves and blood vessels during extended rides.

His finished product, called the Minkow Wedge, is a Y-shaped saddle with the rear portion removed to reduce pressure on critical arteries.

"The solution, ergonomically, wasn't that complicated," said Minkow, who also designed a seat for airline pilots to relieve back pressure on long flights. "You just cut out the part of the seat that presses on the troubled area."

Minkow's seat is among a host of new products designed to offer protection to male cyclists. There are gel-filled seats and seats with cutout holes, and protective biking shorts.

The rush of new products is part of an entire new market in the industry -- ergonomic equipment.

"At first I thought the impotence thing was overrated, but I'm seeing the positive fallout," said Geoff Drake, editor of Santa Cruz, Calif.-based Bicycling magazine. "Now it's incumbent on every saddle-maker to consider the human anatomy when designing their product."

The nerves and blood vessels that feed the penis are funneled through the perineum, the area that lies between the sit bones, doctors say.

While a cyclist is riding a bike, his weight is focused between these pelvic bones. When pressed against the bone, the arteries are compressed, cutting blood flow, resulting in the tell-tale tingling and numbness.

Over time -- like a straw repeatedly flattened that eventually fails to return to its circular shape -- the blood vessels can become scarred and disfigured, resulting in reduced blood flow to the penis. The result is often an inability to achieve or maintain an erection.

Doctors say the pressure on critical arteries can also affect women, temporarily leaving them with reduced sensation.

Minkow and Stanford University urologist Robert Kessler recently studied 25 men -- ages 27 to 62 -- who suffer from bicycle-related medical problems. Of those men, nine complained of erectile dysfunction that lasted anywhere from one month to more than a year.

While Kessler disagrees with Goldstein's estimate of the number of U.S. men suffering from bicycling-induced impotence, he acknowledged that a small percentage of cyclists do progress to full-blown erectile dysfunction.

For the rest, it's more of a minor discomfort.

"As many as 20 percent of men who ride more than six hours a week suffer some numbness -- and some doctors predict as many as 50 percent," Kessler said. "The problem occurs not only after greater number of hours ridden weekly, but also after longer single rides."

Drake, the Bicycling magazine editor, says numbness complaints for years went unspoken among cyclists. "The problem hasn't been traditionally talked about," he said. "But now everyone's admitting to the sensation."

A new candor among cyclists, riders say, is good for the sport.

"We know now numbness is not good," Drake said. "You just don't want to cut off blood supply to any piece of your anatomy. That's a bad idea."