Bicycle Seats and Your Health
Traditional bicycle seats create pressure points which place unhealthy pressure on the prostate, irritate the urethra, damage the pudendal arteries and dorsal nerves, and cause the development of cysts on the tailbone. Traditional bicycle seats inhibit air circulation which contributes to the growth of yeasts, and they irritate the vulvar region, which can become an acute problem for women who have vulvodynia and/or contact vulvitis. But with the SPONGY WONDER BIKE SEAT the pressure is off!:
- The perineum: pudendal arteries and dorsal nerves
- The prostate
- The tailbone
- The privates
No more damage. No more irritation!
The front end of the Spongy Wonder Bike Seats” frame gives as much or more front to rear adjustment than a conventional bike seat does but without the nose is actually 4 inches shorter than most conventional bike seats and so the front end of the frame does not present any hazard.
Three articles published in the current issue of The Journal of Sexual
Medicine concluded that the high pressures in the perineum while straddling
a bike seat compress and temporarily occlude penile blood flow.
The three articles are:
Bike Riding and Erectile Dysfunction: An Increase in Interest. by Huang
Only the Nose Knows: Penile Hemodynamic Study of the Perineum – Saddle
Interface in Men with Erectile Dysfunction Utilizing Bike Saddles and Seats
with and without Nose Extensions. by Munarriz et al
Development of a New Geometric Bike Saddle for the Maintenance of
Genital-Perineal Vascular Perfusion. by Breda et al
New York Times / October 4, 2005 >
Serious Riders, Your Bicycle Seat May Affect Your Love Life
By SANDRA BLAKESLEE
A raft of new studies add to earlier evidence that traditional bicycle
seats, the kind with a narrow rear and pointy nose, play a role in sexual
Dr. Steven Schrader, a reproductive health at the National Institute for
Occupational Safety and Health, said that it was no longer a question of
“whether or not bicycle riding on a saddle causes erectile dysfunction. The
question is, What are we going to do about it?”
J Sports Med Phys Fitness. 2005 Sep;45(3):409-18:
Effect of bike seat design on transcutaneous penile oxygen pressure.
Cohen JD, Gross MT.
Program in Human Movement Science, Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, NC.
AIM: To determine the reliability of monitoring penile transcutaneous oxygen (tpO2) during cycling, and to assess the influence of Bike Seat design and cycling position on tpO2.
METHODS: Experimental design: repeated measures analysis of the effects of bicycle seat design and riding position on tpO2 values. Participants: 31 male cyclists between the ages of 20 and 50 years. Subject inclusion criteria: averaged approx. 80 miles of road bicycling per week during the 2 months prior to enrollment; no history of vascular disease, diabetes, or sexual dysfunction; and had an erection within 15 days prior to study.
MEASURES: mean tpO2 values were calculated for seated and standing positions using 3 current bike seat designs.
RESULTS: Seat design had no significant effect on tpO2 values. Seated cycling significantly reduced tpO2 levels compared with standing cycling.
Mean percent decreases in tpO2 from standing to seated cycling were; Vetta 76%, Terry 73%, and Specialized 62%.
CONCLUSION: None of the bike seats exhibited any significant ability to spare penile tpO2.
Biking may be Hazardous to Your Health – Charles Downey
A 54-year-old Boston attorney figured that as an avid cyclist he was in
great shape. But during a 200-mile, two-day charity event, he noticed his
penis was numb, and for the next month, he had trouble getting, and keeping
He saw Dr. Irwin Goldstein, Professor of Urology at Boston U. School of
Medicine, who suspected the problem was caused by riding a narrow, hard bike
The human rear is perfectly designed to support the weight of the body on
two sit bones2 and as long as you are sitting on a flat surface, like a
chair or couch, your sit bones easily support your weight.
When a man sits on a narrow bike seat, his body weight can crush the
pudendal artery and nerves that serve the penis. So bike riding can result
in temporary and permanent impotence. Extra padding or gel padding in the
seat does not help because the padding bunches up and also cuts off
Doctors at Duke University in Durham, North Carolina and Case Western
Reserve University in Cleveland studied 81 avid bike riders who suffered
from ED. Their findings, published in the December 1999 issue of the Journal
of Urology showed that nerves, arteries, and veins in the perineum can
indeed be damaged by bike seats. Similar results were also seen in a 2001
study published in the International Journal of Sports Medicine.
The research shows that riding with a conventional bike seat typically
causes the amount of oxygen reaching the penis to fall 70 percent to 80
percent in three minutes. “A guy can sit on a bike seat and have his penis
oxygen levels drop 100 percent but he doesn’t know it. After half an hour he
goes numb. Numbness is your body telling you something is wrong.”
Cutting Off the Nose to Save the Penis
Steven M. Schrader, PhD, Michael J. Breitenstein, BS, and Brian D. Lowe, PhD
Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
Introduction. 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) bicycle saddle has been associated with urogenital paresthesia and sexual dysfunction. Aim.
The objective of this study was to assess the effectiveness of the no-nose bicycle saddle as an ergonomic intervention and their acceptance among male bicycle police officers.
Methods. Bicycle police officers from five U.S. metropolitan areas were recruited for this study. Officers completed: (i) the International Index of Erectile Function Questionnaire (IIEF); (ii) computerized pressure measurements at the points of contact on the bicycle; the handlebars, the pedals, and the saddle; (iii) one night of nocturnal Rigiscan® assessment;
(iv) penile vibrotactile sensitivity threshold assessed by computerized biothesiometery.
Officers selected a no-nose bicycle saddle and were asked to use the intervention saddle exclusively for 6 months, at which point they were retested. Main Outcome Measures. Perineal pressure, urogenital numbness, penile vibrotactile sensitivity threshold, erectile function as measure by International Index of Erectile Function Questionnaire (IIEF) and Rigiscan. Results.
After 6 months, 90 men were reassessed. Only three men had returned to a traditional saddle. The results are presented for those who used the no-nose bicycle saddle continuously for 6 months. There was a 66% reduction in saddle contact pressure in the perineal region. There was a significant improvement in penis tactile sensation. There was a significant improvement in erectile function assessed by IIEF. There were no changes noted in the Rigiscan® measures. The number of men indicating they had not experienced urogential paresthesia while cycling for the preceding 6 months, rose from 27% to 82% using no-nose bicycle saddles.
Conclusions. (i) With few exceptions, bicycle police officers were able to effectively use no-nose bicycle saddles in their police work. (ii) Use of no-nose bicycle saddles reduced most perineal pressure. (iii) Penile health improved after 6 month using no-nose bicycle saddles as measured by biothesiometry and IIEF. There was no improvement in Rigiscan® measure after 6 months of using no nose saddles.
Long suspected by the 5 million recreational bike riders and sexual medicine experts, bicycle seat design-shorter noseless seats versus the standard protruding nose extended seat-can directly affect a man’s sexual function, based on the nation’s first prospective study of healthy policemen riding bikes on the job. The study is published in the current issue of the Journal of Sexual Medicine.
Dr. Irwin Goldstein, director, Sexual Medicine Program at the San Diego-based Alvarado Hospital and editor-in-chief of the Journal of Sexual Medicine, wrote an accompanying editorial entitled “The A, B, C’s of The Journal of Sexual Medicine: Awareness, Bicycle Seats, and Choices.”
“For the first time, we have a prospective study of healthy policemen riding bikes on the job, using wider, no-nose bike saddles for six months. Not only did their sensation improve, their erectile function also improved. Changing saddles changed physiology. This is a landmark study for our field that that is important for future riders, and modification of lifestyle showing improvement without any active treatment,” he said.
Ninety bicycling police officers from five metropolitan regions in the United States (Northwest, Southern, Desert West, Midwest, and Southeast) using traditional saddles were evaluated prior to changing saddles and then again after six months of using the noseless bicycle saddle.
The findings show that use of the noseless saddle resulted in a reduction in saddle contact pressure in the perineal region. There was a significant improvement in penile tactile sensation, and the number of men indicating they had not experienced genital numbness while cycling for the preceding six months rose from 27% to 82% using no-nose saddles.
Use of the noseless saddle also resulted in significant increases in erectile function as assessed by the initial evaluation, but there were no significant changes noted in Rigiscan® measures, a method used to record penile rigidity while the subject sleeps. With few exceptions, bicycle police officers were able to effectively use no-nose saddles in their police work and 97% of officers completing the study continued to use the no-nose saddle afterward.
No-nose Saddles for Preventing Genital Numbness and Sexual Dysfunction from Occupational Bicycling
- From the National Institute for Occupational Safety and Health
Workers who ride a bicycle as part of their job may be at risk for genital numbness or more serious sexual and/or reproductive health problems from pressure in the groin (perineum) from the traditional bicycle saddle. NIOSH has conducted studies that have demonstrated the effectiveness of no-nose bicycle saddles in reducing pressure in the groin and improving the sexual health of male bicycle patrol police officers. While most workers in jobs that involve bicycling are men, recent evidence suggests that no-nose bicycle saddles may also benefit women.
Description of Exposure
About 40,000 workers in public safety occupations ride bicycles as part of their job. They include police officers, emergency medical service personnel (EMSs), and security staff who patrol by bicycle.
A number of these workers have reported groin/genital numbness and more severe sexual problems related to prolonged use of a bicycle saddle in their work [NIOSH 2000]. In a study conducted by Schrader et al. , police bicycle patrol officers reported spending an average of about 25 hours per week sitting on a bicycle saddle. Many of them also ride a bicycle for recreation while off duty, and therefore may spend more than 25 hours per week on a bicycle saddle. The traditional bicycle saddle has a narrow nose that protrudes under the groin as the cyclist straddles the bicycle.
Ideally, the weight of the cyclist should be supported on the bicycle saddle under the pelvic sit bones. However, part of the weight is supported where the groin contacts the bicycle saddle nose. Bearing weight on this region of the bicycle saddle compresses the nerves and arteries in the groin (see Figures 1 and 2). These nerves and arteries run through the groin between the sit bones to the genitals. Pressure on these nerves and arteries over time may lead to a loss of sensation and a decrease in blood supply to the genitals. This can contribute to the sexual and reproductive health effects that have been reported.
NIOSH studies [2000, Schrader et al. 2002] showed that male bicycle patrol security officers who complained of groin numbness had night erections that lasted less time than those of a similar group of non-bicycling men. Other NIOSH studies [Lowe et al. 2004; Schrader et al. 2008], showed that pressure on a traditional (nosed) bicycle saddle in the area under the bicyclist’s groin is typically 2.90 pounds per square inch during cycling and may reach as high as 5.37 pounds per square inch. (As a point of reference, the pressure on an arm blood pressure cuff needed to restrict blood flow in the arteries is about 120 mm Hg, which is equal to 2.32 pounds per square inch). This level of pressure is affected by the weight and body shape of the cyclist, the shape and cushioning of the bicycle saddle, and the degree to which the cyclist’s body is tilted forward. Fewer studies of the effects of bicycle saddle use on female cyclists have been conducted. However, recent evidence suggests that women cyclists may also be at risk for a decrease in sensation of their genitals from use of a traditional nosed bicycle saddle [Guess et al. 2006].
Reducing Pressure in the Groin from the Bicycle Saddle
The no-nose bicycle saddle
A number of manufacturers have designed bicycle saddles
to support the weight of the cyclist on their sit bones without a narrow nose of the bicycle saddle protruding forward under the groin region. A no-nose bicycle saddle is designed so that the portion of the nerves and arteries for the genitals that are forward of the sit bones are not compressed against any part of the bicycle saddle surface (see Figure 3). A no-nose bicycle saddle should have no saddle material protruding between the thighs of the cyclist to create pressure in the groin.
NIOSH studies of no-nose saddles
A study by NIOSH [Lowe et al. 2004] showed that bicycle saddles without the protruding nose greatly reduced pressure in the groin that compresses the nerves and arteries for the genitals.
In a more recent NIOSH study [Schrader et al. 2008], the no-nose bicycle saddles were associated with pressure in the groin region of 1.02 pounds per square inch. In a typical pressure picture for a no-nose bicycle saddle, there is very little pressure forward of the sit bones (see Figure 4). The pressure on the nerves and arteries for the genitals may be even lower than 1.02 pounds per square inch because some of the measured pressure was caused by the back of the thighs making contact with the rounded-off front of the no-nose bicycle saddle. The study showed that the no-nose bicycle saddle reduced pressure in the groin by at least 65% (see Figure 5). In the 2008 NIOSH study, more than 90% of officers on bicycle patrol who tried a no-nose bicycle saddle were still using the bicycle saddle after 6 months. These officers believed that no-nose bicycle saddles could be used safely and effectively in their work.
Several of these officers said that it took some time to get used to the no-nose bicycle saddle because it has a different feel than a traditional bicycle saddle.
Contrary to some cyclists’ belief, it is not normal for any part of your body to go numb or lose feeling. Numbness in the groin or genitals is a warning sign that should not be ignored. Workers who ride a bicycle as part of their job* can take the following steps to help prevent sexual and reproductive health problems:
- Use a no-nose bicycle saddle for workplace bicycling. Give yourself time to get used to riding with a no-nose bicycle saddle. At first, it may seem very different from the bicycle saddle you have used in the past. No-nose bicycle saddles may not always be available at retail bicycle shops, but they are readily available for purchase through the Internet.
- Seek guidance on proper bicycle fit from a trained bicycle fit specialist. Use of a no-nose bicycle saddle may require different bicycle saddle height and angle adjustments. Be sure that the no-nose bicycle saddle is adjusted according to the manufacturer’s instructions.
- Dismount the bicycle when at a standstill. Do not lean against a post or other object to stay seated on the bicycle saddle when you are not riding.
- Dismount the bicycle if you begin to have numbness, tingling, or loss of feeling in any part of your body.
The principal contributors to this publication were Steven M. Schrader, Brian D. Lowe, and Michael J. Breitenstein of the Division of Applied Research and Technology, National Institute for Occupational Safety and Health. The International Police Mountain Bike Association has assisted NIOSH in much of the research conducted on this topic.
Guess MK, Connell KA, Schrader SM, Reutman SR, Wang A, Lacombe JA, Toennis C, Lowe BD, Melman A, Mikhail MS . Genital sensation and sexual function in female bicyclists and runners: Are your feet safer than your seat? J Sexual Med 3(6):1018-1027.
International Police Mountain Bike Association . The complete guide to public safety cycling. 2nd ed. Sudbury, MA: Jones and Bartlett Publishers.
Lowe BD, Schrader SM, Breitenstein MJ . Effect of bicycle saddle designs on the pressure to the perineum of the bicyclist. Med Sci Sports Exerc 36(6):1055-1062.
NIOSH . Health Hazard Evaluation Report: City of Long Beach Police Department, Long Beach, CA. By Schrader SM, Breitenstein MJ, Lowe BD. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HETA 2000-0305-2848.
Schrader SM, Breitenstein MJ, Clark JC, Lowe BD, Turner TW . Nocturnal penile tumescence and rigidity testing of bicycling patrol officers. J Androl 23(6):927-934.
Schrader SM, Breitenstein MJ, Lowe BD . Cutting off the nose to save the penis. J Sexual Med 5:1932-1940.
*NIOSH has not studied competitive cycling and can not make recommendations for the relatively small number of workers who ride a bicycle competitively in their occupation.
Just in Case Someone Might Think the Evidence is Lacking…
Published Scientific Research on Bicycle Saddles and the Male Perineum:
1. Bond, R.E. Distance Bicycling May Cause Ischemic Neuropathy of Penis. Physician and Sports Medicine 3:54-56. 1975.
2. Goodson, J.D. Pudendal Neuritis from Biking. N Engl J Med 304:365. 1981
3. Kerstien, MD, S.A. Gould, E. French-Sherry, and C. Pirman. Perineal Trauma and Vasculogenic Impotence. J Urol 127:57. 1982.
4. Solomon, S. and K.G. Cappa. Impotence and Bicycling: a Seldom-reported Connection. Postgrad Med 81:99-102. 1987.
5. Desai, K.M. and J.C. Gingell. Hazards of Long Distance Cycling. Brit J Med 298:1072-1073. 1989.
6. Mellion, M.B. Common Cycling Injuries: Management and Prevention. Sports Med 11:52-70. 1991.
7. Silbert PL, Dunne JW, Edis RH, Stewart-Wynne EG. Bicycling induced pudendal nerve pressure neuropathy. Clin Exp Neurol. 28:191-6. 1991
8. Groenendijk, MC, HCCM Christiaans, CMJ van Hulten. Sitting Comfort on Bicycles. Contemporary Ergonomics pp 551-557, 1992
9. Oberpenning, F. S Roth, DB Luesmann, H van Ahlen, and L Hertle. The Alcock Syndrome: Temporary penile Insensitivity Due to Compression of the Pudental Nerve with the Alcock Canal. J Urol 151:423-5. 1994.
10. Andersen, K.V. and G. Bovim. Impotence and Nerve Entrapment in Long Distance Amateur Cyclists. Acta Neurol Scand 95:233-240. 1997.
11. LaSalle, MD, C Wen, M Choi, P Salimpour, A Adelstein, S Gholami, RJ Krane, and I Goldstein. “You Don’t Have to Ride in the Tour de France”: Erectile Dysfunction in 81 Consecutive Riders. Abstracts of the American Urological Association. 1999.
12. Broderick, GA. Bicycle Seats and Penile Blood Flow: Does the Type of Saddle Matter? Abstracts of the American Urological Association. 1999
13. Schwarzer, U. W. Wiegand, A Bin-Saleh, H Lotzerick, G Kahrmann, T Klotz, and U Engelmann. Genital Numbness and Impotence Rate in Long Distance Cyclists. Abstracts of the American Urological Association. 1999
14. Nayal W, Schwarzer U, Klotz T, Heidenreich A, Engelmann U. Transcutaneous penile oxygen pressure during bicycling. BJU Int. 83:623-5. 1999.
15. Ricchiuti, VS, CA Haas, AD Seftel, T Chelimsky, and I Goldstein. Pudental Nerve Injury Associated with Avid Bicycling. J Urol 162:2099-2100. 1999
16. Sommer, F, D Konig, C Graf, U Schwarzer, C Bertram, T Klotz and U Engelmann. Impotence and Genital Numbness in Cyclists. Int J Sports Med 22:410-413. 2001
17. Marceau, L., K. Kleinman, I. Goldstein, and J McKinlay. Does Bicycling Contribute to the Risk of Erectile Dysfunction? Results from the Massachusetts Male Aging Study (MMAS). Int J Impotence Res 18:298-302. 2001.
18. Sommer, F., U Schwarzer, C Graf, T Klotz, and U Engelman. Changes in penile blood flow during cycling: what precautions should be taken to avoid a decreased profusion? Dtsch Med Wschr 126:939-943. 2001
19. Schwarzer, U., F. Sommer, T. Klotz, C. Cremer, and U. Engelmann. Cycling and Penile Oxygen Pressure: the Type of Saddle Matters. European Urology 41:139-143. 2002
20. Jeong, SJ, K Park, JD Moon, and SB Ryu. Bicycle Saddle Shape affects Penile blood flow. International J Impotence Research 14:513-517. 2002.
21. Keytel, LR and TD Noakes. Effects of a Novel Bicycle Saddle on Symptoms and Comfort in Cyclists. S Afr. Med J 2:295-298. 2002
22. Grunbaum A, K Rehman, I Kuzmarov, and S. Carrier. The Development of a Model to Investigate the Effect of Bicycling on Sexual Function. International J Impotence Research 14:S50. 2002
23. Mumarriz, R. A Prospective Study in Men with ED of Cavernosal Artery PSV Values While Lying, Sitting, Straddling/sitting on different Commercially Available Bicycle Saddle and Seat Designs. International J Impotence Research 14:S60. 2002
24. Taylor, JA. Inherent Variables within Bicycle Riding and Their Relationship to erectile Dysfunction. International J Impotence Research 14:S30. 2002
25. Sommer, F, A Raible, S Wolter, and U Engelmann. Is there any difference in penile blood flow during cycling in an upright vs. reclining position? Andrologia 34:123-153. 2002
26. Schrader, S.M., M. J. Breitenstein, J.C. Clark, B. D. Lowe, and T. W. Turner. Nocturnal Penile Tumescence and Rigidity Testing of Bicycling Patrol Officers. Journal of Andrology 23:927-934. 2002.
27. Mumarriz, R.. Bicycle Riding Associated Erectile Dysfunction: Treatment Outcome of Revascularization Surgery. International J Impotence Research 14:S55. 2002
28. Southorn, T. Great Balls of Fire and the Vicious Cycle. A Study of the Effects of Cycling on Male Fertility. J Family Planning and Reprod Health Care. 28:211-213. 2002
29. Spears, IR, NK Cummins, Z Brenchley, C Donohue, C Turnbull, Shona Burton, and G Macho. The Effect of Saddle Design on Stresses in the Perineum During Cycling. Med & Science in Sports & Exercise 35:1620-1625. 2003.
30. Rando R, R Squadrone, M Sacchi, and A Marzegan. Pressure Distribution on Bicycle Saddles. The Bicycle Saddle Report 2003.Deutsche Sporthochshute. 2003.
31. Sommer F. Type of Saddle and Sitting Position Influence Penile Oxygen Pressure while Cycling. The Bicycle Saddle Report 2003.Deutsche Sporthochshute. 2003.
32. Lowe, B., S. Schrader, and M. Breitenstein. Effect of Saddle Design on the Perineal Pressure of the Bicyclist. Med Sci Sports Exerc. 36:1055-1062. 2004
33. Dettori, JR, TD Koepsell, P Cummins and JM Corman. Erectile Dysfunction after a Long-Distance Cycling Event: Association with Bicycle Characteristics. J Urology 172:637-641. 2004
34. Taylor, JA, TC Kao, PC Albertson, and R Shabsigh. Bicycling Riding and Its Relationship to the Development of Erectile Dysfunction. J Urology 172:1028-1-31. 2004.
35. Leibovitch, I and Y Mor. The Vicious Cycling: Bicycling Related Urogenital Disorders. Eur Urology 47:277-287. 2005
36. Cohen JD, and MT Gross. Effect of Bicycle Racing Saddle Design on Transcutaneous Penile Oxygen Pressure. J Sports Med and Physical Fitness. 45:409-419. 2005.
37. Huang V, R Munarriz, and I Goldstein. Bicycling Riding and Erectile Dysfunction: An Increase in Interest (and Concern). J Sex Med 2:596-604. 2005
38. Munarriz R, V Huang, J Uberoi, S Maitland, T Payton and I Goldstein. Only the Nose Knows: Penile Hemodynamic Study of the Perineum-Saddle Interface in Men with Erectile Dysfunction Utilizing Bicycle Saddles and Seat with and with Nose Extensions. J Sex Med 2:612-619. 2005.
39. Schrader, SM. Research on Bicycle Saddles and Sexual Health Comes of Age. J Sex Med. 2:594-595. 2005.
40. Bressel E, Reeve T, Parker D, Cronin J. Influence of bicycle seat pressure on compression of the perineum: A MRI analysis. J Biomech. 40:198-202. 2007.
41. Gemery, JM, AK Nangia, AC Mamourian, and SK Reid. Digital three-dimensional modeling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction. B J Urology International 99:135-140. 2007
42. Wilson C, and TR Bush. Interface forces on the seat during cycling activity. Clin Biomech. 200722:1017-1023. 2007.
43. Asplund C., T Barkdull, and BD Weiss. Genitourinary Problems in Bicyclists. Current Sports Medicine Reports 6:333-339. 2007
44. Nanka O, Sedý J, Jarolím L. Sulcus nervi dorsalis penis: site of origin of Alcock’s syndrome in bicycle riders? Med Hypotheses. 2007;69(5):1040-5.
45. Standard bicycle seats can lead to erectile dysfunction. Mayo Clin Health Lett. 25:4. 2007.
46. Goldstein I, Lurie AL, Lubisich JP. Bicycle riding, perineal trauma, and erectile dysfunction: data and solutions. Curr Urol Rep. 8:491-7. Review. 2007.
47. Bressel E, Parker D. Effect of Graded Bicycle Seat Pressure on Perineal Compression: An MRI Analysis. Br J Sports Med. 2008
48. Schrader SM, Breitenstein MJ, Lowe BD. Cutting Off the Nose to Save the Penis. J Sex Med. 5:1932-1940, 2008
49. Kennedy J. Neurologic injuries in cycling and bike riding. Neurol Clin. 26 :271-9. 2008
50. Cohen, J. Finding the Perfect Bicycle Seat. 2nd Edition, RBR Publishing Company, South Royalton, VT. 2008.
51. Goldstein, I. The A, B, C’s of The Journal of Sexual Medicine: Awareness, bicycle seats, and choices. J Sex Med 5:1773-1775, 2008.
52. Goldstein, I, M Bastuba, A Lurie, and J Lubisich. Penile Revascularization. J Sex Med 5:2018-2021
Published Scientific Research on Bicycle Saddles and the Female Perineum:
1. Dickerson, RL. Bicycling for Women from the Standpoint of the Gynaecologist. Am J Obstet of Women and Children 31:24-37. 1895.
2. Steiner E, Chague A, Gross GB. [The "third testis" of cyclists, in women too...]Presse Med. 1989 Feb 18:(7):361. French.
3. Groenendijk, MC, HCCM Christiaans, CMJ van Hulten. Sitting Comfort on Bicycles. Contemporary Ergonomics pp 551-557, 1992.
4. McElhinney, BE, T Horner, WW Dinsmore, A Harper, C Goldsmith, and RD Maw. Exercise bicycle-induced vulval abscesses. International J of STD & AIDS 4:174-175. 1993
5. LaSalle M, P Sallinpour, M Adelstein, A Mourzinos, C Wen, J Renzuli, B Goldstein, L Goldstein, J Cantey-Kiser, RJ Krane, and I Goldstein. Sexual and Urinary Tract Dysfunction if Female Bicyclists. J Urol Vol 161 (No 4 Suppl) pp 269 #1040. 1999.
6. Berman J, L Berman, and E Bumiller. For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. Henry Holt & Co. 2001.
7. Buller, JC. Female Cyclists and Perineal Symptoms: An Experimental Bicycle Seat. Clinc J Sprts Med 11:289-290. 2001.
8. Baeyens L, E Vermeersch, and P Bourgeois. Bicyclist's Vulva: Observational Study. BMJ 325:138-139. 2002.
9. Humphries D. Unilateral Vulval Hypertrophy in Competitive Female Cyclists. Br J Sports Med 36:463-464. 2002.
10. Bressel E and BJ Larson. Bicycle Seat Designs and Their Effect on Pelvic Angle, Trunk Angle, and Comfort. Med Sci in Sports & Exercise. 35:327-332. 2003.
11. Frobose I, L Baeyens, and K Tofaute. Ergonomics of 2 Bicycle Saddles - Pressure at the Pudental Area in Women of a Normal Saddle with Gel and of a Saddle with a Hole. The Bicycle Saddle Report 2003.Deutsche Sporthochshute. 2003.
12. Guess MK, KA. Connell1, SM. Schrader, S Reutman, A Wang, J Lacombe, C Toennis, B Lowe, A Melman, and MS Mikhail. Genital Sensation & Female Sexual Function In Cyclists And Runners: Are Your Feet Safer Than Your Seat? Journal of Sexual Medicine 3:1018-1027. 2006.