Introduction: The risk of sexual dysfunction due to bicycling has been addressed in the literature for both men and women. New studies have provided information about the prevalence, pathophysiology, and strategies for prevention of sexual dysfunction as it relates to cycling.

Aim: The aim of this article is to review the current literature about bicycle-related sexual dysfunction in both genders, exclusive of that caused by cycling-related genitourinary trauma.

Methods: A systematic comprehensive review of the English-language literature was performed in March 2014 using PubMed.gov, and search terms including (but not limited to) "cycling, bicycle, sexual dysfunction, and erectile dysfunction."

Results: Several studies have documented a relationship between bicycling and sexual dysfunction. Of the symptoms described, perineal numbness (prevalence of 22-91%) and erectile dysfunction (prevalence of 1.8-50%) are the most commonly reported in the male population. The primary mechanisms leading to these symptoms in both genders appear to be perineal compression of the pudendal nerve within Alcock's canal and possible trauma. Communications have also postulated that potential cycling-related disruption of the hypothalamic-pituitary-gonadal axis, specifically in testosterone signaling, may indirectly lead to sexual dysfunction. Studies have provided evidence that the rider's position on the bicycle, as well as different types of bicycle seats, affect the degree of pudendal compression, and consequently the degree of resultant sexual dysfunction.

Conclusions: Although a number of studies have described mechanisms for cycling-related sexual dysfunction, further validated studies are needed to both better describe the dysfunction, as well as to develop strategies for prevention and treatment. Our best evidence indicates that the type of saddle used, as well as the position of the rider, has more effect on resultant sexual dysfunction than simply participation in cycling. Baran C, Mitchell GC, and Hellstrom WJG. Cycling-related sexual dysfunction in men and women: A review. Sex Med Rev 2014;2:93-101.