Cycling & Pelvic Health: Learn to Protect Yourself

Pelvic health: Discussing bike seat design & handlebar height

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The snow looks like it has made its last stand along the Front Range and for many who have waited for warmer conditions to get back on their bikes, the time is now. As an urogynecologist, I have studied the effects of cycling on female genital health and believe that knowing the right seat design and bike setup for you will provide a more positive riding experience.

Estimates from surveys conducted by the United States Department of Transportation in 2002 suggest that approximately 13 million American women bicycle regularly. With the new trend in spinning classes offered at gyms that number will undoubtedly climb.

The most frequent and serious injuries in both men and women cyclists are the result of collisions with motor vehicles, accounting for more than 250,000 emergency room visits annually. Increasing anecdotal complaints of problems from saddle design, however, have more recently focused attention to the genital region. Saddle-related problems include chaffing, discomfort from ingrown hairs and lymphedema (chronic and permanent swelling of the scrotum and labia) have been documented.

The first studies to evaluate these problems were done in men, where researchers found an association between bicycling and neurological symptoms of numbness in the genital area, erectile dysfunction and poor quality of sperm. These studies were performed by Dr. Steve Schrader from the National Institutes of Occupational Safety and Health (NIOSH) a branch of the CDC and were prompted by complaints from male police who rode bicycles on patrol, making bike riding a potentially occupational hazard.

Why seat design became a focus in genital complaints

The popular cutout middle saddle was first designed to accommodate the male anatomy better than the traditional saddle. Research found that “no-nose” saddles have been shown to decrease pressure in the front of the pelvic area and perineum (area between the rectum and scrotum in men) and increase blood flow to the penis compared to traditional and cutout saddles.

Male police officers that used this saddle design were shown to regain sensation after six months of use (compared to when they rode the traditional saddles); however, they still had decreased erections during their sleeping hours.

Effects of bicycling on women’s genital health

The cutout middle seats have long been marketed as “female saddles,” but there wasn’t data to provide any benefits of this design for women.

The first study to evaluate the effects of cycling on pelvic health in women was a collaborative effort between myself, my colleague Dr. Marsha K. Guess and Dr. Steve Schrader. Dr. Guess and I had previously shown that aging, menopause and childbirth affect the sensation of the genital region, so we were recruited to explore the possibility that biking could also have harmful affects on a woman’s pelvic area.

In our bike study, we compared the sensitivity of the nerves of the genital region between women cyclists and runners. We tested the nerve function by measuring how much vibration stimulus it took before the patients could feel the difference between touch/pressure versus vibration. The women in this study were all under age 50 and none had gone through menopause.

Our findings:

• 60 percent of the cyclists reported having genital pain, tingling or numbness within the previous month of being tested. This is right in range with other studies showing 11-80 percent of women cyclists complaining of these symptoms in other studies.
• We found that the women cyclists had decreased sensation of the genital area (worse nerve function) in the genital region.
• The good news: these healthy women did not complain of having sexual function problems (vaginal lubrication, arousal, orgasm).

Saddle types play a huge role

In this group of women, we also looked at the pressure mapping of the genital region as they rode their bike in a stationary position.  A thin mat was placed on the saddle that measures seat pressures in the genital region as they rode in a stationary position. 55 percent of our participants rode on traditional saddles and 45 percent rode on cut-out saddles.

Our findings:

• On average, traditional saddles caused less pressure at several sites in the perineal region (skin and underlying muscles between the vagina and rectum) compared to cut out saddles.
• Traditional saddles also caused lower peak pressures in these specific sites in the perineal area.
• Use of wider saddles was associated with lower perineal pressures and overall total saddle pressures.
• Despite the differences in the pressures exerted by the saddles, there was no difference in the nerve function (vibration sensory testing) between women who rode cutout versus traditional saddles.
• Both groups were found, however, to have decreased sensation in comparison to runners who didn’t cycle.

Understanding handle bar height

In these subjects, we then looked at the bike fit in terms of handle bar height: above, below or same height as the saddle, and how this affects pressure in the genital area.

Our findings:

• Handlebars positioned lower than the saddle were significantly associated with increased pressure in the perineum; also decreased sensation in the front of the vagina and perineum was discovered.

The bottom line

• Although traditional saddles exert less pressure on the perineum, both traditional and cutout saddles affect genital sensation in women compared to women who don’t cycle.
• No-nosed saddles appear to be beneficial on blood flow and nerve function in men, but these seats are not popular by competitive cyclists.
• Bike fit, at least in terms of handle bar height compared to saddle height, affects saddle pressures and genital sensation. This is likely due to the rider leaning more forward.
• Continue to cycle! It’s fun and healthy! But take breaks from the saddle when the genital area becomes numb or hurts.
• When it’s not possible to stop, try riding out of the saddle for a few minutes to relieve pressure in the genital area and restore blood flow.
• When riding leisurely, consider a wider, soft and possibly no-nosed seat.

Additional research is needed to determine the best bicycle saddle design, bike fit and riding habits. We also need to continue to follow women on the long-term affects on the pelvic nerves and muscles, which are important for our urinary and fecal control. Prolonged cycling affects genital sensation, but long-term effects of hardcore riding on sexual function and function of the pelvic muscles, anal sphincter and bladder – all innervated by branches of the same nerve – are unknown.