Last year, four men (all in their 30s) consulted me with urination problems - urgent and abrupt need to go, dribbling, feeble stream - while also complaining of vague discomfort or actual pain seemingly from the urethra. All had been told it was prostate trouble, and surgery to remove the prostate was even suggested - with a prospect of improvement no better than 50 per cent. This was despite negative prostate-specific antigen (PSA) tests (for prostate enlargement) and clear cystoscopy examinations. They were all finally told that they had prostatodynia (pain in the prostate) of unknown origin and they would just have to live with it.
To me, the mystery wasn't seeing such a cluster of similar patients at around the same time (this happens often), but that there was no proper explanation for their problems. I checked for Chlamydia and other genitourinary infections and disorders, and even tried ambulatory traction to identify any osteopathic problems coming from the sacral nerves. But everything came back negative.
The men had different occupations, though all of them were sedentary - an IT programmer, an accountant, a broker and a lawyer. Also, all were in permanent, stable relationships, and all were health-conscious in terms of their diet, exercise and lifestyles.
I battled on for some time, asking each one more and more detailed questions every time they came to see me. I put them on saw palmetto (Sabal serrulata or Serenoa repens), which blocks the male hormones (dihydrotestosterone; DHT) thought to target the prostate.
Finally, it hit me. Each of the men rode bicycles as their main form of exercise. Were these men putting all their weight on their perineum while sitting on those hard, thin bicycle saddles?
Scouring the medical literature, I found that Dr Kevin O'Brien, of the Southern California Permanente Health Maintenance Organization, had reported two such cases (N Engl J Med, 28 May 1981), as had others more recently (Presse Med, 1987; 16: 399; Pain Digest, 1998; 8: 32-6; Urology, 1997; 49: 809-21).
I advised my four patients of my suspicions and suggested certain changes (stopping cycling or using a softer, wider saddle, with the thinner end pointing downwards). Their pain and discomfort soon disappeared, and their voiding habits returned to normal in all cases. One changed to a recumbent bicycle, while another took up skating - which, some would say, has more cardiovascular benefits to recommend it than does cycling.
I now wonder how many cycling men have undergone unnecessary prostatectomies (with their high risk of impotence)?
I would also like to know the extent of this problem. So, if you have experienced similar pain and discomfort, and have had prostate surgery to deal with it, please forward your story to firstname.lastname@example.org.
Harald Gaier is a registered naturopath, osteopath, homoeopath and herbalist. He can be contacted at The Diagnostic Clinic, London, tel: 020 7009 4650