About the Pudendal Nerve in Cyclists

Saddle Sore? Here’s 5 cycling habits you can make to manage or prevent pelvic floor pain

Cycling is regarded as one of the most popular ways to get a good cardiovascular workout as well as a very common mode of transportation during certain times of the year. As with most exercises and activities, though, there are always things to take into account in terms of effects it can have on our bodies. Cycling can specifically cause some negative side effects to the male pelvic floor. The most common cycling associated urogenital problems are nerve entrapment syndromes which most commonly present as numbness through genitalia and/or erectile dysfunction. This symptom is reported in 50-91% of cyclists worldwide. This can be an effect of overuse, or simply performing activity too much or for too long.

​The main nerve that is affected in nerve entrapment syndrome in cyclists is the pudendal nerve. This nerve is a major structure in the pelvis, aiding in multiple different actions and sensations throughout the pelvic floor. This nerve has both sensory and motor (action) functions. The pudendal nerve innervates the external genitalia as well as the skin around the anus, anal canal, and perineum. It also provides innervation to various pelvic floor muscles, external anal sphincter, and external urethral sphincter.

So, as you can see, if this nerve gets injured, you could be dealing with a wide array of problems! Pedaling while sitting on a slim, hard saddle and being constantly subjected to repetitive impacts generates extreme perineal pressure, which can directly or indirectly compress pudendal nerves. Another area along the path of the pudendal nerve that is commonly affected is further anterior (towards the front of the body). This area can be provoked by leaning forward on your seat, placing increased pressure and friction in that area.

As stated previously, the most common symptoms of pudendal compression are genital numbness followed by erectile dysfunction. Genital numbness is the most common and most recognized symptom and can often time be the only symptom of pudendal nerve compression. Depending on what region of the nerve is compressed, symptoms/numbness can present in different areas of the pelvic floor.

Other less common symptoms include: difficulty achieving orgasm, an altered sensation of ejaculation, reduced sensation of defecation, and perineal pain.

Now, with all of the above-stated information, that does NOT mean that cycling is bad or that males should never cycle and/or if they are, they are doomed. Listed below are multiple different suggestions or tips to help manage and/or prevent these symptoms:

1. Change the riding style and schedules of riding as well as modifying the design of the saddle and its positioning.
Mountain bikes are linked with a higher risk of symptoms rather than road bikes. This is partly due to a more upright posture, which in turn places increased body weight on the buttocks, increasing the risk for nerve compression.
2. Saddle positioning
Increased downward tilt of the nose of the saddle and a limited height difference between the seat and top of the handlebar
Both prevent putting vigorous pressure on perineum, which can be a very vulnerable spot for injury/dysfunction
3. Frequent changes of riding style is highly recommended
4. Taking frequent breaks during long drives as well as regularly alternating between riding in seated and standing positions.
5. Standing up as much as possible during especially rough or bumpy terrain

Biking is a great form of non-impact aerobic exercise that provides countless cardiovascular and overall health benefits. Some of the major benefits include a decreased risk of hypertension, diabetes, and stroke. So, continue to enjoy your bike rides – just be mindful of the above suggestions to keep you riding and feeling your best – all while keeping your pelvis happy!

Leibovitch I, Mor Y. The Vicious Cycling: Bicycling Related Urogenital Disorders. European Urology. 2005;47(3):277-287. doi:10.1016/j.eururo.2004.10.024

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