Genital numbness and other cycling risks: Cause for concern?
Key Takeaways
Cycling-related injuries have been reported in all areas of the body, with traumatic brain injury being the leading cause of cycling-related deaths.
Despite the risks, cycling also provides numerous health benefits, including reduced risk of cardiovascular disease, cancer, and all-cause mortality.
Clinicians should be aware of the risk of exertional rhabdomyolysis in extreme indoor spinning, particularly among new participants.
Cycling is a means of both exercise and transportation across the globe. As with any form of exercise, the cardiovascular and overall fitness benefits usually outweigh the risks. However, clinicians should still be aware of both sides of the equation in order to provide optimal care for their patients.
Injury risks
Cycling is a common cause of exercise-related injury, with up to 85% of all recreational cyclists citing an overuse injury.[] Anatomic regions most often affected by cycling include the neck, wrists, hands, lower back, knees, and perineum, consequent to the uneven pressure distribution experienced while on a bicycle.
In men, cycling has been closely linked to an increased rate of genital numbness, but this did not appear statistically significant with respect to the outcome of erectile dysfunction (ED) in a study conducted by Dr. Breyer, one of the Urology Times authors.[] “These findings suggest that increased cycling may increase risk of inducing perineal numbness, but that itself may not necessarily translate into worsened sexual function.”[]
In a systematic review and meta-analysis of cycling and ED, researchers concluded that there is limited evidence to support a positive correlation between cycling and ED when the data are adjusted for age and comorbidities.[]
In women, Dr. Breyer’s research group found that “women cyclists were no more likely to report sexual dysfunction or urinary symptoms than swimmers or runners.”[]
Of greater concern are road-related incidents consistent with motor vehicle collisions, with one expert noting that “concussions are common in cyclists.”[] Traumatic brain injury (TBI) is the leading cause of death due to cycling injuries, while road rash is the most common injury overall in outdoor cyclists.
Indoor spinning
A particular health concern has arisen from extreme indoor spinning: The risk of exertional rhabdomyolysis.
A systematic review found that most patients were healthy females who had attended their first spinning session.[] Among them, 7.2% developed acute kidney injury secondary to rhabdomyolysis, 4.1% developed thigh compartment syndrome requiring fasciotomy, and 2.1% required temporary inpatient hemodialysis.
The most common symptoms in those presenting with rhabdomyolysis were myalgia, dark urine, and thigh muscle weakness.
Health benefits of cycling
While there are certain risks, cycling also offers health benefits. As noted by authors writing in Urology Times, “Cycling reduces the incidence of cerebrovascular accidents, coronary artery disease, hypertension, dyslipidemia, obesity, and diabetes mellitus.”[]
Studies have shown that middle-aged and elderly individuals who use cycling as their means of transportation to work have lower levels of premature mortality due to all causes, and specifically lower levels of cancer mortality and morbidity.[]
While cycling offers substantial health benefits, clinicians should be aware of potential risks and be prepared to address cycling-related injuries and conditions. Encouraging patients to cycle safely, use appropriate protective gear, and gradually increase exercise intensity can help maximize the benefits while minimizing the risks.
What this means for you
As a physician, it's important to encourage patients to engage in regular physical activity, including cycling, while also educating them about potential risks. When treating cyclists, be prepared to address a wide range of injuries and conditions, from overuse injuries to acute trauma. Stay informed about the latest research on cycling-related health issues, and provide tailored advice to patients based on their individual health status, fitness level, and cycling habits. By taking a balanced approach, you can help your patients enjoy the benefits of cycling while minimizing their risk of injury.