How to stop female saddle soreness

Find a comfy saddle and the right padded shorts, so you can cycle long distances. Photo: Josie Dew (Cycling UK Vice President)

How to stop female saddle soreness

For some women, saddle soreness is the pain that dares not speak its name. Journalist Thomas Henry wonders why more isn't being done to address it.

A lot has been written about cycling and erectile dysfunction in men. A study was conducted back in the 1990s which seemed to link cycling with erectile dysfunction, and since then the saddle manufacturers have been busy making saddles to address this ‘problem’. Perineal pressure was thought to be to blame, so we began to see saddles with cut-outs to relieve that pressure.

Subsequent studies have shown that male cyclists are fairly unlikely to experience erectile dysfunction as a result of their saddle, but the issue is out there in the public domain and is freely discussed. But as the song says: it’s different for girls. It’s worse. Seriously, it is. Much worse. And it’s something that no one seems keen to address, or even talk about.

Cycling media is predominantly male-centric, and even the women’s cycling websites seem surprisingly coy on the subject. You see, blokes can tuck it up front, out of the way.

There may be a bit of side-to-side swing, but mostly the genitals stay out of harm’s way. Women sit on them. And that can cause pain, numbness and sometimes physical damage. an uncomfortable silence I didn’t think about this until recently.

My wife isn’t a regular cyclist, and on the rare occasions she rides a bike she finds it pretty uncomfortable ‘down there’. I had dismissed this as her being unused to cycling, and assumed she meant her bum hurt. It was only when I did a 100-mile charity ride with my friend Tess that I came to realise that, for some women, riding a drop-bar bike for any length of time or distance can be seriously painful. After 70 miles Tess was wincing, and after 100 miles she was visibly distressed. It wasn’t her bum that hurt, she explained, it was her ‘lady parts’.

I really don’t know how female professional cyclists maintain any kind of love-life. The pain lasted for days, and the thought of getting back on the saddle filled me with dread.

Tess

"When I got home, I inspected the damage," said Tess. ‘It was horrific. Swollen, chafed and raw. I really don’t know how female professional cyclists maintain any kind of love-life. The pain lasted for days, and the thought of getting back on the saddle filled me with dread."

I had no idea that this might be a problem for female cyclists, mostly because I’m a bloke and had never given it much thought. I was horrified that my friend had suffered so much and subsequently discovered there isn’t a huge amount of advice out there about this problem. There is some info available, but you have to dig to find it.

At this point, I should probably say that if you are of a sensitive disposition or uncomfortable with discussions about genital anatomy, you may want to skip to another article. I also have to admit that this was quite a difficult article to write; I am a middle-aged, married man and don’t much talk about this stuff with my wife of 26 years, let alone complete strangers of the opposite gender. But this is an important topic. So apologies if this is an uncomfortable subject. It is one that needs to be talked about and resolved if we are to address the imbalance between the numbers of men and women cycling.

Undercarriage issues

On a Dutch-style bike with an upright riding position, the sit-bones (ischial tuberosities) and glutes take most of the rider’s weight, and that’s generally comfortable. On a road bike, the rider leans much further forward, the pelvis is tilted forwards, the sit-bones take less weight, and more weight is placed on the soft tissue further forwards: the external genitalia.

When a woman sits on a road racing bike saddle, even if it’s for a sportive or other non-competitive ride, her vulva – something that wasn’t designed to be weight-bearing – may be required to take up to 40% of her body weight. For hours at a time. Part of the problem is that in order to adopt the most aerodynamic position, a woman needs to be in the worst possible position for her vulva. This, it seems to me, is a serious problem.

Dr Marsha Guess, of the Department of Obstetrics & Gynaecology at Yale University School of Medicine, published a paper in the Journal of Sexual Medicine in 2006 entitled ‘Genital Sensation and Sexual Function in Women Bicyclists and Runners’. She compared competitive female cyclists and runners using quantitive sensory testing, and found that the cyclists who cycled for more than 100 miles a week experienced significant reduction in genital sensation and a significant increase in pain and numbness, leading some to experience incidences of female sexual dysfunction.

Anatomy lessons

More specifically, nearly two-thirds of the cyclists reported genital pain and numbness and 10% reported actual genital injury: compression of the pudendal nerve, and neurological damage to soft tissue and lymphatic vessels. British Cycling carried out a survey of pro women cyclists concerning saddle issues, and almost all reported problems to some degree. Some had suffered such serious labial swelling that they had to undergo surgery, says Phil Burt, head of physio at British Cycling, who believes too many women riders are embarrassed to seek help for the problem. ‘If you have seriously swollen labia, it’s quite personal to talk about, but it really needs addressing as soon as possible,’ he says.

Obviously pro cyclists spend way more time in the saddle than recreational cyclists, but the problem exists for some women even after relatively short rides. One of the problems with addressing these issues is the diversity of female genitalia – as with any anatomical issue, everyone is different. It’s impossible to make anything other than broad generalisations. There is a similar diversity in men, but male genitalia is higher and further forward in relation to the pelvis. Irrespective of size and shape, men’s genitals can be tucked up and forward, out of harm’s way. The vulva, on the other hand, is situated underneath the pelvis, in the worst place possible for bike riding.

Cobb Cycles, an American specialist bike saddle maker, divides female genitalia into two types: ‘innie’ and ‘outie’. What they mean is that some women have small labia minora (the sensitive inner lips of the vulva) that are mostly enclosed and protected by the labia majora (the less sensitive outer lips of the vulva), while others have larger labia minora which project beyond the labia majora. They call the former an innie, the latter an outie. I’m not keen on the use of euphemisms but that’s how Cobb classify them, and some women’s cycling websites seem more comfortable using these terms.

Of course, within each type there are many variations, but generally speaking ‘innies’ seem to have fewer problems than ‘outies’ with regard comfort on the bike. And this is the thing: everyone’s different. ‘I’ve been lucky, I’ve had very few problems over the years,’ says Marijn de Vries, the recently retired pro racer from Holland. ‘My only experiences with swollen labia have been when I’ve been time trialling, because then I am locked into the same position and I can’t move around to relieve the pressure.’

Riding position

The most significant issue is with riding position: the more aero and stretched out, the more the pelvis is rotated forwards and the more weight is placed on the vulva. The easiest solution is not to ride a racy road bike but to choose something like a hybrid or mountain bike, with a relatively upright riding position. This will put more weight on the glutes and sit-bones, and less on delicate soft tissue. Riding a recumbent will also solve the problem – albeit radically.

However, many female cyclists do not want to be constrained in this way and are looking for ways to get comfortable on a road bike. ‘Riding position is key to achieving comfort,’ says Jimmy Wilson of CycleFit in London. ‘We’ve seen people who have tried many different saddles and never managed to get comfortable… but they’ve put each saddle in exactly the same position. If that position is wrong, no saddle is going to be comfortable.’

‘My advice would be to start with a fairly upright riding position,’ says de Vries, ‘maybe with a few spacers under the stem or the stem flipped upwards, and then try and get more aerodynamic over time. If you build up your core strength, that can give you more control over your position and your pelvis.’

One of the problems, particularly for smaller women, is that small bike frames often have compromised geometry in order to fit 700C wheels into a small frame. They may put the rider in a stretched-out position, or shift the weight further forward due to a steep seat tube angle. If the reach to the bars is a long one, there is a temptation to shuffle forward slightly on the saddle in order to reach the bars more comfortably, but this has the effect of moving the sit-bones forward of their optimum position on the saddle, again putting more weight on the vulva. The same thing can happen if the crank length is too long, or the cleats are in the wrong position on the shoes.

‘You want your contact points with the bike to be skeletal, not soft-tissue,’ says Wilson. ‘It’s essential to get all the contact points (saddle, pedals and handlebars) correctly set before worrying too much about the saddle. Once those contact points are set to the right positions, then it’s time to start thinking about the saddle itself.’

The advice from pretty much everyone I spoke to was that if you really want to ride a drop-bar bike, and haven’t been able to get comfortable, then go to a reputable bike fitter and get a bike fit. And explain to him/her any issues involving labial pain. Yes, it may be embarrassing, but this is your health at stake. Appraised of all the facts, a skilled bike fitter should be able to set you up in a position that is an acceptable compromise between aero-efficiency and personal comfort.

The right saddle

This is such a personal issue that giving model-specific advice in a magazine is almost pointless. Trial and error is the best solution. While researching this article, I found myself in the strange position of talking to random strangers in the street about their saddle and soft tissue comfort (amazingly no one slapped me in the face). The consensus of those conversations was that saddles with cut-outs were better than those without, wide and squishy saddles were a no-no, and things like the Adamo were good for some but not for others.

While it’s tempting to go with personal recommendations from friends or club-mates when choosing a saddle, these may not work out due to the differences in anatomy that we’ve discussed. Far better is to go to a bike shop that offers saddle trials and try a few out. Some will let you ride a saddle for a week or so, others will put you and your bike on a turbo-trainer and let you ride a variety of saddles.

‘For me, it was trial and error,’ says de Vries. ‘But I was lucky and found the right saddle quite quickly. Some bike fitters use an electronic system for measuring the pressure on your saddle. It’s like a kind of plastic cover that goes over your saddle, and it contains many pressure sensors. When you ride the bike on the turbo they can see on the computer screen where the pressure points are, and this will show you straight away what might take four hours on the road to discover.’

Wilson is also a fan of this system, which they use at CycleFit. ‘It gives us the ability to look at precisely how much pressure is coming from the saddle, it allows us to see exactly where the sit-bones are on the saddle, and it traces the changes in the centre of pressure on the saddle, which shows us how the pelvis is moving on the bike.’ The ability to see on screen what the rider is feeling allows the fitter to adjust the contact points and also try out different saddles to find the optimum fit.

A bike fit with pressure-mapping doesn’t come cheap (around £350), but as Tess said ‘I would cheerfully have paid £350 not to have to go through that level of discomfort ever again!’ An extreme case, maybe, but many riders can benefit from even a fairly basic bike fit.

With regards things you can try at home: tipping the nose of your saddle down by a degree or two (no more than that) may help alleviate pressure; and riding out of the saddle every 10 minutes or so can also help reduce pressure and keep the blood flowing. It’s also a good idea to think about whether your reach to the bars is moving you too far forward on the saddle. Consider a shorter stem and/or one with a greater upright angle.

When you find the right saddle, buy two. I regularly see posts on chat forums from people who have had the perfect saddle, only to find that it’s been discontinued and they can’t get another.

What to wear

If there’s one thing I would recommend spending serious money on, it’s on a decent pair of bib-shorts. Yes, £130 is a lot of money for a pair of shorts, but you may find it’s the best £130 you ever spent. You can easily get five years’ use out of good quality bib-shorts, so £25 a year works out as pretty good value. Again, recommendations from friends are fine, but with bib-shorts you tend to get what you pay for.

For women, good bibs are really important because of the pressure and chafing issues. ‘A really good, well-fitting pair of bib-shorts will definitely help,’ says de Vries. ‘Yes, toilet breaks become more difficult, but the bibs keep the pad firmly in place and make them much more comfortable. And you should use plenty of chammy cream.’

And seriously: never wear underwear under your Lycra shorts.

Surgery?!

Constant weight-bearing on soft-tissue is not only very painful, it can also result in serious inflammation and infections of the labia that can sometimes require surgery. ‘Labial abscesses that needed to be drained or excised were very common during my racing career,’ says former Women’s Hour Record holder Bridie O’Donnell (who also happens to be a doctor), ‘and every season, three or four of my teammates would undergo surgery for this.’

Some riders, primarily those with an ‘outie’ physiology, have even had preventive surgery. This is absolutely the last resort for most female cyclists, but it’s not as uncommon as you might expect. Dr Angelica Kavouni (MD, FRCS, EBOPRAS) runs a cosmetic surgery practice in London’s Harley Street, and she performs around 250 labiaplasties a year, primarily for cyclists and horse riders.

This involves surgically reducing the size of the labia minora, a procedure that takes about an hour and which costs around £3,000. That may seem like a pretty extreme solution, but for some women – notably racers – this is a solution if they want to ride a road bike pain-free.

And finally…

If all of the above sounds horrifying, don’t worry: almost all soft-tissue discomfort issues can be resolved with a bit of patience and perseverance. By concentrating on your position on the bike, you should be able to get your saddle in the right position. It’s then a question of trail-and-error when it comes to finding the right saddle for you, and it may not be as difficult as you think. If you do suffer any physical injury, get it treated by a doctor as soon as possible.

And a word to the male readers: if your wife/partner/girlfriend complains of pain ‘down there’, don’t underestimate it. Instead, try to imagine riding for four hours while sitting on one of your testicles. Then support her while she looks for a solution. 

While no saddle fits everyone, here are some that might suit

ISM Adamo PN 1.1
£109.99
‘Noseless’ design is intended to remove soft tissue pressure. This one is 110mm wide. Wider models are available. 

Selle Italia SLR Lady Flow
£102.99
The lighter (185g), racier stablemate of the Diva Gel Flow that we reviewed (Feb/Mar 16). It’s 131mm wide.

Brooks
B17S Standard
£82.99
Classic leather saddle that becomes shaped to fit you as it wears in. It’s 177mm wide. Black, brown or honey. brooksengland.com

Specialized Women’s Riva
£25
Budget saddle for riding on road and off, the ‘Body Geometry’ cutout promises improved comfort. It’s 155mm wide. 

Could bib shorts help?

bib-shorts offer the best comfort but can be inconvenient…toilet stops are complicated by bib-shorts. Jersey, jacket, and possibly helmet all need removing in order to peel down the bibs to take a pee.

I’m reliably informed that the hoist-pull-squat method is worth perfecting. The technique is to hoist one leg of the bibs as high as it will go, pull it all the way over to the other leg, squat down and pee through the gap. It takes a bit of practice, but it’s quick, fairly easy, and doesn’t expose your bum to passers-by.

Alternatively, ‘quick release’ bib-shorts are (at last!) available.

1. Dare2b AEP Descender Bibbed Cycle Short £65

Unhook the bib straps at the front, pass them over your head, and you’re ready. Feeding the strap back after isn’t as quick. Sizes: 8-20. 

2. Pearl Izumi Women’s Pro Escape Bib Short £109.99

The rear strap on these bib shorts detaches so that the shorts can be dropped without undressing to your base-
layer. Sizes: XS-XXL. 

3. Giro Women’s Ride Halter Bib Short £119.99

Instead of shoulder straps, these bib shorts have a halter neck. Pull that over your head and you can lower the shorts without disrobing. Sizes: XS-XL. giro.com

This article was first published as Saddled with Pain in the June/July edition of Cycle (the magazine for Cycling UK members). Join today to receive 6 issues of Cycle magazine per year. 

 

Share your advice for preventing female saddle pain, by using the comments box below. 

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