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The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study

BMJ 2011; 343 doi: (Published 04 August 2011) Cite this as: BMJ 2011;343:d4521

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Infertility and important genitourinary tract morbidity not even mentioned

Dear Editor,

This study did not take into account important morbidity associated
with cycling.

As potential health risks, only road traffic incidents and exposure
to air pollution were included.

Genitourinary tract injuries, pudendal nerve entrapment, erectile
dysfunction, infertility in both men and women(!), priapism, penile
thrombosis, hematuria, torsion of spermatic cord, prostatitis, perineal
nodular indurations, elevated serum PSA levels, were not even mentioned.
[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11]

Studies have demonstrated that a high percentage of cyclists are
affected by all these pelvic symptoms.

Failing to include all this cycling-associated morbidity has
compromised Authors' final conclusions, regarding the amount of health
risks associated to cycling, in my opinion.


[1] Sports Med. 2011 Jun 1;41(6):463-76. doi: 10.2165/11588740-
Effects of bicycle saddle height on knee injury risk and cycling
Bini R, Hume PA, Croft JL.
Sport Performance Research Institute New Zealand, School of Sport and
Recreation, Auckland University of Technology, Auckland, New Zealand.

[2] Urologe A. 2011 Feb;50(2):188-96.
Influencing of the PSA concentration in serum by physical exercise
(especially bicycle riding).
Kindermann W, Lehmann V, Herrmann M, Loch T.
Institut fur Sport- und Praventivmedizin, Universitat des Saarlandes,
Campus, Gebaude B8.2, 66123 Saarbrucken, Deutschland.

[3] J Sex Med. 2010 Oct;7(10):3424-33. doi: 10.1111/j.1743-
Association between attributes of a cyclist and bicycle seat pressure.
Bressel E, Nash D, Dolny D.
Biomechanics Laboratory, Utah State University, Logan, UT 84322, USA.

[4] J Sex Med. 2010 Jul;7(7):2346-58. Epub 2010 Jan 19.
Bicycle riding and erectile dysfunction: a review.
Sommer F, Goldstein I, Korda JB.
Department of Urology, Institute of Men's Health, University Medical
Centre Hamburg-Eppendorf, Hamburg, Germany.

[5] Curr Urol Rep. 2007 Nov;8(6):491-7.
Bicycle riding, perineal trauma, and erectile dysfunction: data and
Goldstein I, Lurie AL, Lubisich JP.
San Diego Sexual Medicine, Alvarado Hospital, 6655 Alvarado Road, San
Diego, CA 92120, USA.

[6] BJU Int. 2007 Jan;99(1):135-40.
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.
Gemery JM, Nangia AK, Mamourian AC, Reid SK.
Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
03756, USA.

[7] J Sex Med. 2005 Sep;2(5):612-9.
Only the nose knows: penile hemodynamic study of the perineum-saddle
interface in men with erectile dysfunction utilizingbicycle saddles and
seats with and without nose extensions.
Munarriz R, Huang V, Uberoi J, Maitland S, Payton T, Goldstein I.
Institute for Sexual Medicine, Department of Urology, Boston University
School of Medicine, 720 Harrison Avenue, Suite 600, Boston, MA 02118, USA.

[8] J Sex Med. 2005 Sep;2(5):596-604.
Bicycle riding and erectile dysfunction: an increase in interest (and
Huang V, Munarriz R, Goldstein I.
Institute for Sexual Medicine, Department of Urology, Boston University
School of Medicine, 720 Harrison Avenue, Boston, MA 02118, USA.

[9] J Urol. 2004 Aug;172(2):637-41.
Erectile dysfunction after a long-distance cycling event: associations
with bicycle characteristics.
Dettori JR, Koepsell TD, Cummings P, Corman JM.
Department of Epidemiology, School of Public Health and Community
Medicine, University of Washington and Department of Urology, Virginia
Mason Medical Center, Seattle, USA.

[10] Eur Urol. 2005 Mar;47(3):277-86; discussion 286-7. Epub 2004
Dec 30.
The vicious cycling: bicycling related urogenital disorders.
Leibovitch I, Mor Y.
Department of Urology, Meir Medical Center, Affiliated to Sackler School
of Medicine, Tel Aviv University, 59 Tchernichovski st., Kfar Saba,

[11] J Appl Physiol. 1984 Jun;56(6):1453-63.
Endurance training effects on plasma hormonal responsiveness and sex
hormone excretion.
Bullen BA, Skrinar GS, Beitins IZ, Carr DB, Reppert SM, Dotson CO, Fencl
MD, Gervino EV, McArthur JW.

Competing interests: No competing interests

23 September 2011
Stavros Saripanidis
Consultant in Obstetrics and Gynaecology in Greece
Private Sector, 55131