Many people. I’m sure look at a bike saddle and think that not only must it be uncomfortable It’s probably also bad for you. You know – Cause damage, pain, numbness and for men perhaps erectile dysfunction, prostate cancer maybe. And yet many of us ride bikes a lot and don’t suffer from any issues at all. Some cyclists on the other hand do. I have done and so I can tell you that if something happens, it’s really worrying. Look – this is my “Oh my god! My penis has gone completely numb!” face. We’ll come back to that because we’re investigating the issues surrounding men’s health and cycling to do that we’ve teamed up with one of the foremost urologist here in the UK – a guy called Anthony Koupparis – to give solid and practical advice that all male cyclists should listen to and if you need a reason other than his extensive clinical experience to believe what it says, he’s also an Ironman and those guys spend a lot of time in the saddle. Before we get started though here is a quick anatomy lesson. This is me riding a bike. This is now a skeleton riding a bike and this… Ready… Is a close-up of a penis. Stop stop sniggering at the back. It’s not mine alright, nor is it necessarily to scale. Anyway jokes aside it is really important to be able to understand our own anatomy. You will be familiar I’m sure with the penis and testicles usually tucked nicely out of the way when you’re riding The soft tissue area between your bum and your testicles is called your perineum And when you are sat on the bike this area is in contact with your saddle. Under the skin you have your urethra, which is the tube that connects your bladder with the outside world via the penis. In the perineum you also have major blood vessels and your pudendal nerve which gives sensation to the area and therefore also helps with getting an erection. Above the perineum you have your prostate which is a gland that creates seminal fluid and which the urethra passes through Because of our anatomy and the shape of saddles it seems reasonable to make the link between cycling and pundendal pain or numbness, erectile disfunction, and with prostate problems, but let us look into it a little bit more closely. Although don’t worry. It is not going to get any more graphic than what you’ve already seen You suggested Anthony that we break this subject down So we’ve got numbness erectile dysfunction and also prostate related specifically prostate cancer Let’s start with numbness then and first of all, can I tell you my numb penis story? – That’d be, yeah … I feel I feel we know each other well enough for you tell me about that. It was when I was at a wind tunnel in Indianapolis and we were doing a wind tunnel test in which case you have to sit on a bike pedaling gently for 30 minutes whilst your bike does a full sweep of wind angles. What it means You have to be completely motionless in your upper body because any kind of twitch will distort the results. So it’s a really artificial situation which to ride a bike and after the 30 minutes I’ve got off and I realized quite quickly that I had absolutely no sensation at all in my penis What’s actually going on because fortunately, you know sensation did return So ultimately I don’t think anything long-term has happened but short term what what’s going on? Basically, because because of the pressure that you’re exerting directly on the perineum you’re pressing on the nerves and you’re pressing on some of the blood vessels and that’s what’s causing the numbness. So after a period of time when you’ve been sitting on a nerve it will undergo some very minor damage not long-term damage, but basically end up causing numbness in the area that it supplies and that’s what happened to you. So it’s kind of the equivalent then of of going to sleep in an odd position and waking up and your arms completely dead and It’s massively disconcerting but sensation returns quite quickly and and there’s no long-term damage. Very similar to that exactly right. So what should we actually do about it then? If we’re suffering from numbness having been riding the bike what what’s the first port of call? If you find something happening like that you get on the bike and it’s numb afterwards well then clearly you need to get it sorted out and what that would involve is you’ll know more than I do you get a proper bike fit and you get someone to have a look at your saddle and everything that goes with that. Now if you get on your bike for prolonged periods and every single time It’s numb in that area and it continues to be numb and then you do the same again and again and again then Absolutely inevitably you will cause some long-term damage But it common sense takes over and if it happens once then just get a proper bike fit and get a proper saddle. A one-off period of numbness after that will not cause any long-term damage either to the sensation in that area or to anything like erections and stuff like that So the next topic then would be erectile dysfunction and given what we heard about about numbness is there a link then between cycling, repeated numbness leading to erectile dysfunction? – The answer’s no. The more important thing is the significance of erectile dysfunction in the first place. The processes that give you erection problems are exactly the same as the processes that give you cardiovascular disease, that give you a heart attack so if you’ve got diabetes or high blood pressure or you smoke, then you are likely to have erectile dysfunction but you’re also likely to have heart disease. The fact is that most middle-aged blokes will take up cycling it seems at the moment. Now if you’re a cyclist and you’re of that particular age and you develop erectile dysfunction your first thought should not be “Oh, it’s my saddle is just because of the cycling” It should be I’m not gonna put my head in the sand about it This could be a marker for something that’s undiagnosed I need to get this checked. You seem quite comfortable with the fact that it would be quite difficult to inflict the sort of amount of damage on your pudendal nerve that would then lead to erectile dysfunction. So is it actually quite hard to do that? The odd bit of numbness affecting your perineum is not going to give you erectile dysfunction And actually it doesn’t give you erectile dysfunction. Go and get it checked out. Firstly to have a proper MOT [test/thorough check] from a heart point of view then why not have some treatment for erection problems? I mean they it’s gone full circle It’s gone from being this sort of slightly sniggering thing to a proper health issue which you can get sorted out. And then finding them. What about – prostate related issues and more specifically prostate cancer. Is there a link to cycling? Thankfully Cycling has no effect on prostate cancer. But it’s not only the development of prostate cancer is it’s also the question of whether you get inappropriately investigated for prostate cancer. So one of the things that we use to give an indication of a risk of prostate cancer is by doing a blood test and there is a thought that if you cycle lots you might irritate your prostate and that might artificially put your blood test up which is called a PSA blood test a prostate specific antigen blood test that puts it up You have that blood test done It’s artificially raised and then you have a whole Load of investigations that you never needed all because you were cycling and actually that’s not true Not it – there’s the possibility that it might affect it a little bit but if you look at laboratory based research on lots and lots of molecular markers for prostate cancer actually cycling and exercise don’t make any difference to Any of the indicators for prostate cancer so cycling is good It makes you fitter, it improves your cardiovascular health all the things that reduce your risk of cancer and And it has no effect on An inappropriate set of investigation for prostate cancer. And then moving on from that It doesn’t thankfully give you a high risk of prostate cancer. What we should be doing as blokes is having a think about it So as we get older, we’re more likely to get prostate cancer. So the first thing is to be aware of some of the symptoms now The things that we look out for are things like water work symptoms, pain in your back Problems with bleeding in the water, those sorts of things If you’re worried about those things if you’re experiencing those things Then you should go to either a urologist or GP and have a sensible discussion about being assessed. That doesn’t Automatically mean that you’re going to get checked for prostate cancer But that particular doctor will take you through the good things about getting checked and potentially the downsides of getting checked Then you can both make a decision about whether to carry on or not What we don’t want is blokes just completely ignoring it in the first place. And in most cases we find these things much more early these days and it can be completely sorted. What kind of age Are we talking about here? What kind of age of man should be starting to get concerned? And I appreciate there’s probably tragic examples of you know early cases But… You’re right. So and with my in my practice, I’ve got a very skewed picture So we have such big practice that you’ll have patients from, you know in their 30s upwards to you know, 80s and 90s But certainly as you get beyond 50 You should be having a think about it and if you’ve got some worrying symptoms don’t panic don’t put your head in the sand and have a sensible discussion and assessment about What the problem is, whether there are any red flags to act on and whether you need some more Investigations rather than not doing anything about it. So there is no link between cycling and prostate cancer but prostate cancer is a big issue for a large proportion of cyclists purely because they’re men, they’re middle-aged and Therefore they need to think about it exactly Now, I don’t know about you But my biggest take-home I think from that conversation with Anthony is that we should probably not take our health for granted we should confront our own mortality and actually seek help when we need it because Not doing things is probably the biggest problem that we’re all going to face Now I probably shared a little bit too much information when I told you about my numb penis in the wind tunnel But I think in the spirit of that maybe we should all try and have a conversation With maybe our friends on the club run it this weekend have a conversation at least about this video I think that would be a positive place to start. Now also Please make sure it gives me a big thumbs up to thank Anthony for his time and sharing his incredible experience with us and if you’d like to watch another video Related to this subject. We’ve got one over on this channel right now, which helps you actually buy the right saddle for you So confronting that first issue of numbness head-on.