While hormone balance, autonomic nervous system function, anatomic and other factors are necessary aspects of case management for erectile dysfunction, the capacity of the local vascular system to regulate blood delivery to the tissues of interest is as important for sexual as it is for cardiac function. No wonder a paper just published in the Archives of Internal Medicine provides evidence that lifestyle modification of cardiovascular function improves erectile dysfunction. The authors state:

“Erectile dysfunction (ED) shares similar modifiable risks factors with coronary artery disease (CAD). Lifestyle modification that targets CAD risk factors may also lead to improvement in ED. We conducted a systematic review and meta-analysis of randomized controlled trials evaluating the effect of lifestyle interventions and pharmacotherapy for cardiovascular (CV) risk factors on the severity of ED.”

They examined multiple electronic databases from randomized controlled clinical trials with follow-up of at least 6 weeks of lifestyle modification intervention or pharmacotherapy for cardiovascular risk factor reduction. Their main outcome measure was differences in the International Index of Erectile Dysfunction (IIEF-5) score. Their data demonstrated significant effectiveness:

“A total of 740 participants from 6 clinical trials in 4 countries were identified. Lifestyle modifications and pharmacotherapy for CV risk factors were associated with statistically significant improvement in sexual function (IIEF-5 score): weighted mean difference, 2.66. If the trials with statin intervention (n = 143) are excluded, the remaining 4 trials of lifestyle modification interventions (n = 597) demonstrate statistically significant improvement in sexual function: weighted mean difference, 2.40.”

Readers may wish to search this site for several reports on the cautions and limitations associated with statin use. There are, however, no risks associated with skillful lifestyle modification of CV risk factors. The authors conclude:

“The results of our study further strengthen the evidence that lifestyle modification and pharmacotherapy for CV risk factors are effective in improving sexual function in men with ED.”

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The standard bicycle seat can deliver a significant insult to the nerve and blood vessel supply to the male genitalia. There have been numerous studies investigating the relationship between bicycle riding and erectile dysfunction. The authors of a paper published a while back in The Journal of Sexual Medicine that reviewed the science set out to:

“…summarize accumulating data on the safety of bicycle riding based on medical evidence categorized by levels of evidence, including case reports, observational studies, case control studies, mechanistic studies, and population-based epidemiologic investigations. The secondary aim was to address the concerns of bicyclists and propose measures to minimize the risk of ED associated with bicycle riding.”

The mass of data revealed a clear picture and yielded specific recommendations:

“Bicycle riding more than 3 hours per week was an independent relative risk for moderate to severe ED. Therefore, bicycle riders should take precautionary measures to minimize the risk of ED associated with bicycle riding: change the bicycle saddle with a protruding nose to a noseless seat, change the posture to a more upright/reclining position, change the material of the saddle (GEL), and tilt the saddle/seat downwards.”

The authors note in their conclusion:

“Straddling bicycle saddles with a nose extension is associated with suprasystolic perineal compression pressures, temporarily occluding penile perfusion and potentially inducing endothelial injury and vasculogenic ED.”

In a subsequent paper published in the same journal this year the authors revisit the problem and begin by noting:

“For many years, reports in the literature have implicated bicycle riding as causing increased risk of erectile dysfunction (ED). Perineal compression during cycling has been associated with the development of sexual complications.”

They conducted a comprehensive review of the scientific literature and found that further studies had firmly established the risk of cycling-related sexual dysfunction and extended it to females:

“There is a significant relationship between cycling-induced perineal compression leading to vascular, endothelial, and neurogenic dysfunction in men and the development of ED. Research on female bicyclists is very limited but indicates the same impairment as in male bicyclists.”

The authors of a review published earlier in European Urology caution practitioners to be aware of this widespread phenomenon. They report that a range of problems have been documented:

“The most common bicycling associated urogenital problems are nerve entrapment syndromes presenting as genitalia numbness, which is reported in 50–91% of the cyclists, followed by erectile dysfunction reported in 13–24%. Other less common symptoms include priapism, penile thrombosis, infertility, hematuria, torsion of spermatic cord, prostatitis, perineal nodular induration and elevated serum PSA, which are reported only sporadically.”

They conclude by exhorting practitioners to be alert:

“Urologists should be aware that bicycling is a potential and not an infrequent cause of a variety of urological and andrological disorders caused by overuse injuries affecting the genitourinary system.”

Perhaps this could contribute, at least to some degree, occurrences of ‘cyclist road rage’. Are there any remedies or recommendations for cyclists to follow? Another study in The Journal of Sexual Medicine investigated the condition in police officers:

“The average bicycle police officer spends 24 hours a week on his bicycle and previous studies have shown riding a bicycle with a traditional (nosed) saddle has been associated with urogenital paresthesia and sexual dysfunction.”

The officers manifested the typical problems, but also demonstrated some improvement when using a ‘no-nose saddle’:

“(i) With few exceptions, bicycle police officers were able to effectively use no-nose saddles in their police work. (ii) Use of no-nose saddles reduced most perineal pressure. (iii) Penile health improved after 6 month using no-nose saddles as measured by biothesiometry and IIEF. There was no improvement in Rigiscan® [nocturnal erection] measure after 6 months of using no nose saddles, suggesting that a longer recovery time may be needed.”

It only makes anatomical sense that insult to the nerves and blood vessels that supply the genitalia could cause sexual dysfunction in both males and females.

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Two papers recently published in the Journal of Sexual Medicine document the benefit of the low glycemic Mediterranean diet for sexual function in both women and men. The authors of Adherence to Mediterranean Diet and Sexual Function in Women with Type 2 Diabetes evaluated how well they stuck to the diet and correlated it with sexual function…

“The Female Sexual Function Index (FSFI) was used for assessing the key dimensions of female sexual function.”

What did the data show?

“Diabetic women with the highest scores (of adherence to the diet) had lower BMI, waist circumference, and waist-to-hip ratio, a lower prevalence of depression, obesity and metabolic syndrome, a higher level of physical activity, and better glucose and lipid profiles…The proportion of sexually active women showed a significant increase…of adherence to Mediterranean diet…women with the highest score of adherence had a lower prevalence of sexual dysfunction…These associations remained significant after adjustment for many potential confounders.”

The authors of Adherence to Mediterranean Diet and Erectile Dysfunction in Men with Type 2 Diabetes conducted a similar investigation for men. This time the International Index of Erectile Function-5 was used as a metric for sexual function. Here’s what the data showed:

“The proportion of sexually active men showed a significant increase…of adherence to Mediterranean diet. Moreover, men with the highest score of adherence were more likely to have a lower prevalence of global ED and severe ED as compared with low adherers.”

No surprise, right? Low glycemic vegetables and fruits, lots of olive oil, nuts, a little wine, etc: the Mediterranean Diet.

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Gentlemen, this paper published recently in the journal Urology represents one of many studies linking erectile dysfunction with the hormonal and vascular degeneration associated with insulin resistance in metabolic syndrome (earlier stage) and type 2 diabetes (more advanced). “In our study, the presence of T2DM [type 2 diabetes] was strongly associated with severe ED in patients with MS [metabolic syndrome]. We believe that components of MS should be taken into consideration in the diagnosis and treatment of ED.” If you like sex, take care of your blood sugar and insulin receptors.

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