Cycling, Chafing, Clits, & Climax: Bike Riding & Saddle Sores
- Mo Frazier
- Feb 14, 2024
- 17 min read
Updated: Jun 17, 2024
By Mo Frazier, DNP, CNM, ARNP
Note: In this blog and in the highlighted studies, the terms "female" and "woman" refer to individuals who are cisgender and have vulvas.
Table of Contents
Over the winter, while cross-training to soothe my very angry peroneal tendon, I took a break from running and hopped on my indoor stationary bike. Everything was going smoothly, or so I thought, until I noticed some labial discomfort despite my recently purchased, budget-friendly Amazon bike shorts. Spoiler alert: sometimes opting for the cheapest sporting gear can really backfire (we'll explore the intricacies of cycling equipment shortly).
The discomfort escalated to the point where I found myself shifting my weight on the saddle more often than my toddler trying to avoid nap time.
Before long, this awkward saddle dance led to another issue—knee pain. Now, if there’s one thing athletes are good at, it’s enduring pain in the name of sport. But when the knee pain joined the vulvar agony party, I decided it was time for a deep dive into the mysterious world of saddle discomfort. And wow, what an adventure that was! I unearthed a mountain of information (and plenty of misinformation) about cycling and vulvar health that no one ever teaches you— surprise! As a nurse practitioner specializing in women's health and an athlete myself, I was shocked by the widespread prevalence of these challenges and the surprising lack of attention from bike experts and cycling enthusiasts when it comes to ensuring comfort, function, and health for female riders. It's a telling reminder that in the world of cycling, just like many other sports, the distinctive needs of women often go unrecognized.
From reading posts where women normalized saddle pain and endured it for years (cue the collective eye roll and centuries of women being gaslit into thinking their discomfort is imaginary), to delving into qualitative research studies detailing elite female cyclists forced into retirement due to labial lumps and pudendal nerve damage, it is glaringly obvious that this is a major issue.
Amidst a sea of troll comments on social media suggesting we toughen up and drawing parallels with the normalization of missed periods in sports culture, it's crystal clear: we can't just accept this pain. It's like history repeating itself with menstrual health issues leading to discoveries like the Female Athlete Triad, Functional Hypothalamic Amenorrhea, and Relative Energy Deficiency in Sport (REDs).
Just as pain with intercourse shouldn't be brushed off as normal, with the expectation that "it gets better with time," neither should pain while cycling. The idea of a "breaking-in" period is just as nonsensical in cycling as it is when it comes to sex and pleasure.
So, here we are! My goal with this post is to build on the excellent information shared in a recent Bicycling article that’s been buzzing in female athlete health circles. Instead of rehashing what they’ve already covered, I’ll offer a gyn-focused, evidence-based perspective on all things related to cycling and vulvar health. We’ll chat about all the things - chafing, chamois cream, and yes, even how cycling affects sexual health.
Saddle up, because this post is packed with spicy historical intrigue (spoiler alert: it's a rollercoaster of exclusion, lack of diversity, and some seriously overlooked female physiology), and cutting-edge product technology. My goal is to cultivate a secure space that's well-prepared, informed, and mature enough to engage in these important discussions and disclosures.
LET'S RIDE!
First things first, some fast facts to boost awareness about prevalence:
In a 2023 Bicycling survey and in other surveys, nearly 50% of female respondents disclosed long-term genital swelling or disfigurement, with 16% reporting ongoing numbness.
Buller et al. reported genital numbness in 70% and vulvodynia in up to 80% of 180 female cyclists.¹
53.9% of cycling participants met the diagnostic criteria for female sexual dysfunction (FSD), along with 58.1% reporting genital numbness and 69.1% reporting genital pain.²
43.5% of women said they had been deterred from cycling due to vulval/perineal discomfort. The commonest symptom experienced was pain, 37.4%, followed by chafing, 33.3% and redness, 26.6%. Just over a fifth of women had experienced infections they attribute to cycling: 9.8% urinary tract infections, 7.5% vulvovaginal candida and 3.1% bacterial vaginosis.³
A 2022 scoping review examined existing evidence on saddle sores, with a focus on definition, prevalence, prevention, and management. The review included 17 studies, predominantly on males (13 studies), with only 2 studies focusing on females. This highlights a gender disparity in research, with saddle sores being underrepresented and mainly a male-dominated issue.⁴
Research focusing on women's perineal health in cycling is limited.⁵
Alright, let's dig into this ever-present problem and explore the beef between the vulva and the not-so-beefy cycling saddle.
But first, let’s talk anatomy.
Anatomy + Friction + Pressure. The pudendal nerve plays a critical role in sensation and function in the genital region for both men and women. Research indicates that female cyclists experience significant decreases in pudendal nerve sensory function, similar to their male counterparts.⁵ This is often due to compression injuries sustained while cycling, which can compromise the normal function of the main neurovascular bundle of the vulva. In addition, the combination of increased friction and pressure against the clitoris, which has both external and internal components nestled within the labia minora, and the saddle during cycling, can result in discomfort or irritation.
This pressure can compress the blood vessels traveling with the pudendal nerve, leading to reduced blood flow, also known as ischemia. Over time, this ischemia can cause pudendal vascular insufficiency, where the nerve doesn't receive enough oxygen and nutrients due to the restricted blood flow. The consequences of pudendal vascular insufficiency are significant. It can lead to symptoms such as numbness (neuropathy), pain, and decreased sensation in the genital area. This condition can also cause long-term damage to the nerve, affecting sexual function and overall comfort.
Simply, squashing delicate vulvar tissue repeatedly over time can mess with major sensory and motor nerves that are essential for sexual function and pleasure.
Anatomy + Friction + Moisture + Heat. The combination of the mons pubis and labia majora, with their abundance of adipose tissue, hair follicles, and numerous sweat glands (sebaceous, apocrine, and eccrine), coupled with friction, moisture, and heat, creates a perfect storm for saddle discomfort in female cyclists.
While the vulva acts as the primary defense against genital tract infections and relies on crucial pH levels to maintain its delicate microbial balance, it's not impenetrable. The normal and healthy microbial community, comprising various species like staphylococci, micrococci, lactobacilli, and yeasts, sourced from areas like the vaginal, urethral, colonic, and intertriginous skin, can sometimes overgrow when the environment is disrupted. This disruption weakens the body's immune response, heightening susceptibility to infections.
Factors that can disrupt this environment or influence pH levels include both endogenous and exogenous elements. Endogenous factors such as humidity, sweat, vaginal discharge, menstruation, urine and fecal contamination, genetics, and age can all play a role. Exogenous factors like sperm, soap, detergents, cosmetic products, lubricants and spermicides, tight clothing or sanitary pads, and shaving can also contribute to disruptions in the vulvar environment and pH levels.⁶
Basically, on any day of your menstrual cycle, especially during your period, rocking tight bike shorts and breaking a sweat can leave your vulva feeling a bit crotchety. Sure, it's a bit of a bummer, but don’t stress. There are savvy strategies to outsmart this issue and step up your defense game.
Anatomy + Changes Over Time. Understanding the nuanced physiological differences among females and acknowledging individual anatomical variations are crucial when addressing cycling and vulvar health, especially considering changes over time. While our bodies are indeed remarkable and adaptable to life's various stages, it's important to recognize that these anatomical transformations can significantly impact comfort and function. This is particularly important when we realize that cycling is not exclusively for young people.
During childbirth, the labia may swell due to the passage of the baby through the birth canal and the impact of maternal hormones. Hormonal changes during pregnancy can also cause puffiness or alterations in the shape of the labia majora and minora, along with changes in color and the development of varicose veins due to increased blood flow. Decreased estrogen levels during lactation and perimenopause may lead to thinning, dryness, and reduced elasticity of vulvar tissues and the vaginal lining, according to the North American Menopause Society.⁷
Subsequently, during lactation and post-menopause, the decline in estrogen and progesterone levels can lead to overall skin tissue atrophy, affecting the vulva and labia. Understanding your anatomy is crucial for maintaining comfort and enjoyment, especially as your body undergoes changes.
So considering what we know about anatomy, what in the actual F were they thinking when they designed these narrow, rigid saddle contraptions?!?!
History. It's no surprise that the cycling world has long favored designs catering exclusively to male anatomy, especially when the first studies on cycling and genital health focused solely on men. This oversight extends beyond saddles to a broad range of women's sports gear.
From shoes that ignore the unique biomechanics of female feet to protective gear that fails to consider breast anatomy, the list of neglected needs is extensive. A recent example is Nike's Team USA track-and-field unitard, which featured a high-cut bikini line, widely criticized by female athletes for being impractical and ignoring diverse body shapes and sizes.⁸
But I digress….
These initial studies on cycling were led by Dr. Steve Schrader from the National Institutes of Occupational Safety and Health (NIOSH), a branch of the CDC. They were prompted by complaints from male police officers who experienced numbness, erectile dysfunction, and poor sperm quality from riding bicycles on patrol.⁹
These findings led to the development of the popular cutout middle saddle, designed to better accommodate the male anatomy compared to traditional saddles. Research showed that male officers using this saddle regained sensation after six months, although they still experienced decreased erections during sleep. Notably, this saddle was not initially designed with female anatomy in mind—a glaring oversight, but unfortunately, not surprising in a field historically dominated by male-centric designs.
Reports of potential neurovascular compression injuries from cycling led to the cutout saddle being heavily marketed to women cyclists. Despite its widespread popularity and strategic marketing, limited studies including female cyclists have failed to demonstrate a protective effect for women using these cutout saddles - leaving many riders scratching their heads (and other parts) in frustration.
In fact, a study by Guess et al., demonstrated that different saddle designs can significantly affect perineal pressure.⁵ Traditional saddles exhibit pressure in three primary patterns: over the bilateral ischial, widely distributed along the posterior saddle and ischial tuberosities, and isolated to the perineal region. However, the cutout saddle, despite its intended design to relieve pressure, actually increased pressure along the edges of the cutout, causing the labia to swell into the hollow.
Signs and Remedies. What are some signs of a problem, and the evidence-based recommendations, guidelines, and suggestions to prevent them?
While we await more research for comprehensive evidence-based recommendations, I've gathered what we know so far. Let's dive into this comprehensive guide, ensuring you're armed with factual insights and steering clear of any dubious advice from Sub-Reddits.
When it comes to common cycling conditions, female athletes face a variety of issues that can be categorized by the systems they affect. For example, "cyclist vulva" or "saddle sore" encompasses a range of integumentary or dermatologic conditions, from initial redness, chafing, pain, and loss of sensation to more severe issues like ulceration and chronic unilateral swelling of the labia majora. Other common dermatologic conditions include vulvar cysts, Bartholin's cysts, vulvar irritation or erythema, recurrent boils or abscesses (perineal furunculosis), blisters, vulvar lichen sclerosus, vulvar lichen simplex chronicus, and nodular or lumpy changes (perineal nodular induration).
In addition to these skin changes, pain-related conditions such as vulvodynia, and those causing numbness or tingling like perineal neuropathy, are also prevalent among female cyclists. Furthermore, hypertrophy or edema in the vulvar, labial, clitoral, perineal, vaginal, urethral, and rectal areas can occur. Vaginitis conditions, such as yeast infections and bacterial vaginosis, are also common due to the moist and warm environment created by prolonged cycling, which can disrupt the natural balance of the vaginal microbiome. Understanding these conditions and their potential remedies is crucial for maintaining comfort and health while cycling.
Female Sexual Dysfunction. Recent scientific research has shed light on Female Sexual Dysfunction (FSD), a multifaceted issue encompassing a range of concerns including insertional dyspareunia and decreased libido. A study involving 178 female cyclists revealed that a striking 58% experienced genital numbness, a significant marker of sexual dysfunction. Addressing urogenital pain and numbness among female cyclists is crucial, as they can profoundly impact sexual well-being. Genital pain and numbness from cycling were strongly associated with both decreased arousal and satisfaction with orgasm in females. Additionally, prevalent issues like dyspareunia and vulvodynia further compound the complexity of FSD. Other challenges such as orgasmic dysfunction and vaginismus contribute to the multifaceted nature of this condition.¹⁰, ¹¹, ¹²
Here are some evidence-based recommendations for the most common cycling-related conditions, beneficial not only for managing vulvar pain, health, and hygiene but also for promoting sexual well-being.
Comprehensive List of Tips and Strategies for Preventing and Managing Cycling-Related Vulvar and Genital Health Issues:
Bike Fit and Equipment.
Several studies have investigated the relationship between saddle design, saddle fit, and the prevention of saddle sores. For example, a study by Bury et al. found that saddle shape significantly influenced pressure distribution and could affect the occurrence of saddle sores.¹³ Similarly, a study by Bressel et al. examined the effect of saddle width on saddle sores and found that wider saddles distributed pressure more evenly, reducing the risk of sores.¹⁴ Additionally, a study by Spears et al. investigated the role of saddle tilt and reported that adjusting saddle tilt could help alleviate pressure and reduce the incidence of saddle sores.¹⁵
Proper Bike Fit: The first priority is getting a proper bike fit, which includes selecting the right saddle and positioning it correctly. The saddle is central to your overall bike fit. If you change your saddle, it's important to reassess and adjust your bike fit to ensure optimal comfort and performance. Spend time making sure your bike is fitted correctly for your frame to prevent most problems. This includes the correct height and type of seat to distribute pressure on the ischial tuberosities rather than the labia, and handlebars that do not require you to stretch too far forward. Having trouble finding a good bike fitter in your area? Check out this article from Bicycling for some great tips.
Adjust Saddle and Handlebars: A more upright cycling position is essential for reducing pressure on the labia and preventing perineal injury. Studies show that an anterior pelvic tilt, common when leaning forward over low handlebars, significantly reduces the available space under the pubic symphysis. This reduction increases the risk of compressing the pudendal nerve and artery, leading to numbness and discomfort. Raising the handlebars helps maintain a more upright sitting posture, minimizing anterior pelvic tilt and preserving the space under the pubic symphysis, thereby reducing the likelihood of compression-related issues.
3. Consider a Woman-Specific or Broad-Based Saddle: Saddles with grooves, gel, or wide designs can help avoid trapping or squashing of the labia. Brands often allow trial with full return policies.
4. Use No-Nosed Saddles: Beneficial for blood flow and nerve function, especially during leisurely rides.
Top-Rated Saddle Options (Including Both Traditional and Cutout Designs) Specifically Tailored for Women:
Please note, this list is not endorsed by GynSport Lab
5. Wear High-Quality Bib Shorts: Look for dense, compressive Lycra to prevent chamois migration. Avoid underwear under cycle gear to prevent chafing.
In a compelling study by Larsen et al., the effects of cycling shorts padding on perceived discomfort and saddle pressure distribution among female cyclists were meticulously examined under laboratory conditions.¹⁶ Two distinct pad types were crafted and evaluated: a conventional pad with padding covering the ischial tuberosities and crotch area (full-pad), and an innovative pad with padding exclusively at the ischial tuberosities (half-pad). Through assessment utilizing a visual analogue scale, the researchers determined the rate of perceived discomfort (RPD) over the ischial tuberosities and crotch area. Additionally, the displacement of the center of pressure (COP) was measured in both anterior-posterior and medial-lateral directions using a pressure mat. Surprisingly, the study revealed that pad design had no discernible effect on RPD at the ischial tuberosities or crotch area, nor did it impact the standard deviation and sample entropy of the COP displacement. While these findings shed light on the intricacies of saddle pressure distribution, it prompts reflection on the essential qualities of cycling shorts.
Instead of solely focusing on pad design, cyclists are encouraged to seek shorts with antimicrobial benefits, breathability, and consider exploring bib shorts. Despite initial reservations about their appearance, bib shorts offer superior comfort by eliminating the waistband that often digs into the stomach. Moreover, advancements in design now allow for convenient bathroom breaks with pull-down bib shorts, making them a practical and comfortable choice for cyclists seeking enhanced performance and comfort on the road.
Top-Rated Bib Short Options Designed Specifically for Women:
Please note, this list is not endorsed by GynSport Lab
6. Skip the Dryer: Always air-dry your shorts to maintain the integrity of Lycra and chamois foam.
Clothing and Hygiene.
Women face unique challenges in cycling, such as vaginal discharge and urinary leakage, which can seep into the chamois and create a breeding ground for bacteria. Unlike men, women's genitalia contribute to this issue more significantly. Especially during multi-day tours where restroom facilities may be limited, it's essential for women to be prepared.
Wear the Right Clothing: Use padded cycle shorts without underwear. Wash shorts immediately after each ride and use a fresh pair.
2. Go Commando: Avoid underwear to reduce friction and potential for micro-tears and saddle sores.
3. Proper Personal Hygiene: Change out of sweaty bike shorts immediately post-ride. Keep the genital area clean and dry. Use feminine wipes if a shower is not possible.
4. Keep it Clean: Wash and dry your bib shorts thoroughly, following manufacturer’s instructions. Hang up chamois until you can do your laundry.
*Excess discharge: When embarking on longer cycling journeys, managing vaginal discharge becomes essential for comfort and hygiene. Carrying feminine wipes offers a practical solution, effectively removing excess discharge during rides. For extended trips, particularly multi-day tours, it's advisable to pack multiple sets of bike shorts. Swapping into fresh shorts periodically not only minimizes discomfort but also mitigates the accumulation of discharge and bacteria in the chamois, ensuring optimal hygiene and comfort throughout the ride. Additionally, prioritize bike shorts crafted from breathable, moisture-wicking fabrics to enhance ventilation and moisture control, further enhancing your riding experience.
*Wearing period-proof underwear under cycling shorts: Wearing period-proof underwear under cycling shorts may not be the most comfortable option for everyone, as it could potentially create additional friction depending on the fit and material of both the underwear and the shorts. However, some individuals may find it to be a convenient solution for managing menstruation during cycling, especially if they prefer not to use pads or tampons. It's essential to consider personal comfort and preferences when choosing how to manage menstruation while cycling.
Skin Care and Lubrication.
Lubricants: Interestingly, there is limited research specifically examining the effectiveness of chamois cream in preventing saddle sores, anecdotal evidence from cyclists and a few small-scale studies suggest its potential benefits.
Apply chamois cream or petroleum jelly-based lubricant to the labia, groin, and inner thighs to prevent chafing and saddle sores. Be cautious with chamois creams that contain cetearyl alcohol as it can have a drying effect on vulvar skin.
Chamois cream versus petroleum-based jelly lubricants: What's the difference and when should you opt for one over the other?
Chamois cream and petroleum-based jelly lubricants are both used in cycling to reduce friction and chafing, but they have distinct differences. Chamois cream typically contains moisturizing and anti-chafing agents like lanolin and shea butter, providing a creamier and less greasy consistency compared to the thicker, more slippery texture of petroleum-based jelly lubricants, which primarily consist of petroleum jelly or mineral oil. While chamois cream is specifically designed for cycling shorts and chamois pads, petroleum-based jelly lubricants can be applied to any area prone to friction. Chamois cream offers lubrication, skin protection, and soothing properties during long rides, while petroleum-based jelly lubricants may lack the same soothing effects. Overall, chamois cream is tailored for cyclists with added skin benefits, whereas petroleum-based jelly lubricants provide basic lubrication and protection against chafing.
Top-Rated Cycling Chamois Creams and Lubricants:
Please note, this list is not endorsed by GynSport Lab
Using petroleum jelly-based lubricants effectively reduces friction during cycling. However, after using water-soluble or petroleum jelly-based lubricants, immediate skin cleansing is crucial to prevent pore blockage. While many turn to alcohol-based skin astringents for post-ride lubricant cleansing, these products can dry out the skin and potentially disrupt the natural vulvovaginal microbiota, increasing the risk of itching or infections like yeast infections. To mitigate these risks, opt for gentle, pH-balanced products tailored for intimate hygiene. Intimate wipes serve this purpose well. They maintain pH balance, are hypoallergenic, and come individually wrapped for on-the-go convenience. These wipes efficiently remove residue without causing irritation or disturbing the skin's natural pH balance.
*Remember, less is more—don't be a Paula Deen! Petroleum jelly lubricant can be challenging to clean out of bike shorts due to its oil-based nature, potentially causing stubborn stains and affecting fabric elasticity and breathability. It may also degrade chamois padding and compromise seam integrity over time. To mitigate these effects, thorough cleaning after each use with a gentle detergent is recommended. Additionally, limiting the use of petroleum jelly and opting for water-based or chamois cream alternatives can help preserve the quality of bike shorts.
Top-Rated pH Balancing Intimate Hygiene Wipes for Cyclists:
Please note, this list is not endorsed by GynSport Lab
Hair Removal.
Be Careful with Hair Removal: Pubic hair reduces friction. Avoid shaving or waxing within 48-72 hours before a long ride. Laser removal is preferred to reduce the risk of infection.
Hydration and Bladder Care.
Hydrate: Drink plenty of water and empty your bladder without delay to prevent urinary tract infections. (raising the handlebars and adjusting the saddle angle can reduce pressure on the perineum and urinary tract.
Treatment of Infections and Sores.
Antibiotic Creams: Use local antibiotic creams for skin and labial sores. Steroid or hyaluronidase injections can be considered for more severe sores. Apply bacitracin once a day for persistent sores. Consult a provider if symptoms persist or if you develop a fever.
Warm Compresses: Apply warm compresses a couple of times a day to ease the pain of saddle sores.
General Riding Tips.
Stand Up Regularly: To reduce chafing, friction, and numbness, stand up for one or two pedal strokes every few minutes. Although there isn't firm research on the ideal frequency, a good rule of thumb is to stand for 30-60 seconds every 10 minutes of riding.
Take Breaks: Take breaks from the saddle when the genital area becomes numb or hurts. Riding out of the saddle for a few minutes can relieve pressure and restore blood flow.
Special Considerations:
Pregnancy: Adjust your position or bike as needed during pregnancy to accommodate your growing belly and comfort level.
4. Vulvar Hygiene:
Avoid Harsh Intimate Hygiene Products: Many intimate hygiene products can upset vulvovaginal pH, affecting the normal microbiota needed for protection against infection.
Saying it louder for the people in the back: Social media platforms like TikTok and Instagram are witnessing a peculiar trend, with influencers promoting the idea that vaginal cleansers, masks (yes, you heard that right), and perfumes are must-haves for cleanliness and a fresh scent.
But let's talk facts: Your vagina IS your body's self-cleaning oven, equipped with a natural discharge that acts as the cleaning crew. When harsh chemicals gatecrash this party, they disrupt the delicate balance, inviting unwanted guests like infections and inflammation.¹⁷ Just as harsh chemicals can mess up an oven's self-cleaning process, they can throw the delicate balance of the vagina's microbiome out of whack.
5. Use Hypoallergenic Products: If you must use a feminine hygiene wash, make sure it is hypoallergenic, soap-free, pH-friendly, mildly cleansing, contains no irritants, protects against dryness, and maintains balanced microflora. It's important to use washes sparingly and choose products that are specifically formulated for intimate use.
Bicycle Design and Alternatives.
Recumbent Bikes: Consider high-performance two-wheel recumbents. They are designed to provide a more comfortable riding position by distributing weight more evenly and reducing pressure on the perineum and genital area. These bikes can be as fast and as safe as traditional road bikes in traffic. Recumbents support the back and distribute the rider's weight over a larger area, significantly reducing pressure on sensitive areas. This can be especially beneficial for those with chronic genital discomfort from traditional bike saddles.
Additional Tips.
Vaginal Estrogen: Research suggests that female cyclists with thin, delicate skin, particularly those experiencing vulvovaginal atrophy (VVA), may benefit from vaginal estrogen therapy. Studies published in the Journal of Sexual Medicine and Menopause found that low-dose vaginal estrogen treatment effectively improved symptoms of VVA, such as vaginal dryness and irritation, enhancing comfort and quality of life for participants, including cyclists. These findings are supported by guidelines from organizations like the North American Menopause Society (NAMS), which recommend vaginal estrogen therapy as a first-line treatment for vulvovaginal symptoms associated with menopause, emphasizing its safety and efficacy in improving vaginal health and comfort.¹⁸
2. Consult Professionals: Get a professional bike fit and consult a healthcare provider for persistent or severe issues.
Recent data and narratives reveal the significant pathologies associated with cycling sores, highlighting the surprising prevalence of vulvar and labial reconstruction among riders. This doesn't have to be your fate. Prevention is absolutely crucial. There are solutions to avoid these severe outcomes, but they often involve plastic surgery and reconstruction, which are serious matters.
If you start noticing labial toughening or numbness, it's a critical signal to pause, reassess your saddle and fit, and consult your gynecologist to monitor tissue changes. Don't let it get to the point of requiring major interventions—take proactive steps now.
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