Cycling-Related Erectile Dysfunction in Men: Evidence on Neurovascular Mechanisms and Prevention

Abstract

Cycling is one of the most popular forms of physical activity worldwide and provides numerous cardiovascular, metabolic and psychological health benefits. However, prolonged cycling exposure has also been associated with genital numbness, perineal discomfort and erectile complaints in some male cyclists. The aim of this narrative review was to summarize current evidence regarding cycling-related erectile dysfunction (ED), with particular emphasis on epidemiology, neurovascular mechanisms and preventive strategies. A literature search of the PubMed database was conducted for studies published between January 2016 and March 2026 using keywords related to cycling, erectile dysfunction, genital symptoms, saddle pressure and pudendal neuropathy. Of 67 initially identified publications, 33 underwent full-text evaluation and 15 studies were included in the final review. Current evidence does not support the conclusion that cycling itself is a universal cause of ED. Large observational studies and meta-analyses demonstrated comparable erectile function scores between recreational cyclists and non-cycling controls despite a higher prevalence of genital symptoms among cyclists. Increased ED risk was observed mainly in individuals exposed to prolonged riding duration, high cumulative saddle pressure and occupational or endurance cycling. Proposed mechanisms include pudendal nerve compression, transient reductions in penile blood flow and oxygenation, and repetitive perineal microtrauma. Preventive measures such as optimized bicycle ergonomics, pressure-relieving saddle designs and periodic standing during riding were associated with lower symptom prevalence. Cycling remains a generally safe form of physical activity for most men, although prolonged exposure and unfavorable bicycle ergonomics may contribute to genital and erectile symptoms in susceptible individuals. Further prospective studies are needed to better define long-term risk and optimize prevention strategies.