Pelvic/Perineal Trauma
In young men, erectile dysfunction may be caused by pelvic/perineal trauma—blunt trauma to the perineum, which is the area between the scrotum and anus. Direct trauma to the perineum can result from a bicycle riding and/or injury, a karate kick, getting hit with a hockey stick, falling onto an object, saddle-horn injury from horseback riding, or other accidental injury. (Collinge 2009) The trauma can cause vascular problems in the penis and result in erectile dysfunction.
Bicycle riding and erectile dysfunction has been the subject of many studies. An investigative team from Boston University School of Medicine reviewed 35 studies published from 1981 to 2004. They found that three hours or more per week of bicycle riding was an independent risk factor for moderate to severe erectile dysfunction. In case control studies, they found the prevalence of moderate to severe erectile dysfunction in bicyclists was 4.2 percent and 4 percent, respectively, when compared with age-matched runners (1.1%) and swimmers (2%). (Huang 2005)
The penis is attached deep within the perineum and ends near the anus. This region houses Alcock’s canal, which is where the nerves and arteries enter the penis. If there is direct trauma of sufficient force or duration to the perineum, the penile artery can get crushed and the endothelium may be injured. Such perineal trauma can result in reduced blood supply to the penis, either immediately after the trauma occurs or developing gradually over months to a year or more.
Erectile dysfunction caused by pelvic/perineal trauma may be treatable using penile revascularization. Emotional trauma often accompanies erectile dysfunction associated with pelvic/perineal trauma because it usually develops in young, otherwise healthy men, and so psychological counseling is important as well.
See also
Can your bike seat give you ED?
References
Collinge CA et al. Saddle-horn injury of the pelvis. The injury, its outcomes, and associated male sexual dysfunction. J Bone Joint Surg Am 2009 Jul; 91(7): 1630-36
Huang V et al. Bicycle riding and erectile dysfunction: an increase in interest (and concern). J Sex Med 2005 Sep; 2(5): 596-604
