Mountain biking linked to scrotal and testicular disorders

Saddle sore and more – the private perils of mountain biking

An Austrian study of extreme mountain bikers has found an almost universal incidence of scrotal disorders, suggesting a high rate of repeated sub-clinical ‘traumatisation’ of the scrotal contents from saddle vibrations and shocks arising from rough terrain.

The researchers, from University Hospital Innsbruck, used high-resolution ultrasonography to investigate whether amateur mountain bikers had a higher frequency of extra-testicular and testicular disorders than non-bikers. The 45 bikers studied all worked at their sport for at least two hours per day, six days per week, covering distances of more than 5,000k per year.

All the bikers underwent clinical assessment, including a history of pain, discomfort and scrotal trauma or inflammation, as well as scrotal inspection and palpation for swelling, tenderness, hardening or other abnormalities. The results of these tests were compared with those performed on a control group of 31 healthy medical students with no history of cycling.

The findings for the two groups were dramatically different:

* 43 of the 45 bikers – a staggering 96% – were found to have pathological abnormalities of the scrotal contents, compared with just five (16%) of the controls;
* of the bikers with abnormalities, half also had scrotal tenderness, discomfort or suspicious findings on palpation, while the healthy controls were all without symptoms.

The only abnormality among the controls was a cystic swelling called spermatocele. But, while this problem affected only five of them, it affected 22 of the mountain bikers, possibly caused by repeated ‘microtraumatisation’ of the epididymis, where sperm are stored.

The commonest abnormalities found in bikers on ultrasonography were benign calcified masses known as scrotoliths. Other common abnormalities were testicular and epididymal calcification, and hydroceles – accumulation of watery liquid in the sac surrounding the testes;

The good news was that testicular microlithiasis (stone formation – a sign of testicular cancer) was not significantly more common in the bikers.

The researchers assumed that the abnormalities they found in bikers were caused by problems with their saddles. So what can mountain bikers do to protect these most vulnerable parts of their bodies? The researchers offer the following suggestions:

* Improve padding of the seat and/or shorts;
* adjust the saddle angle to either a horizontal or upward in front position;
* adjust the saddle height;
* use an ergonomically-designed saddle;
* take frequent rest stops during rides.

‘Furthermore,’ they conclude, ‘new shock-absorbent saddles and full suspension bikes might help reduce saddle vibration and microtraumatisation so that mountain biking remains a relatively safe and healthy sport.’

The Lancet, vol 356, October 21, 2000, p1414

Isabel Walker

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