When it Comes to Tulips, It’s Not All Roses Part I: Women’s Saddle Pain

By ADMIN 0 Comments

by Elizabeth Bouchard, PCI #905-B/EMSCI #204-B
University of Guelph (ON) Campus Community Police
IPMBA Treasurer

In 2018, I purchased a new bike as an early Christmas gift to myself. I sprang for my dream bike: a beautiful, woman-specific enduro that can shred my area bike park and manage all my local trails with ease. It is by far the most expensive bicycle I’ve ever purchased, but my justification was that it alone could do what two other bikes have done in the past, thus taking up less space in my garage and costing less to maintain.

Since I would be investing so heavily in it, I took the extra step of getting it properly sized and adjusted. Imagine my surprise when I finally got it out on the trail and I discovered that the saddle was causing me pain. I’m not talking simple discomfort; I’m talking PAIN. Pain that did not go away. Pain that got a lot worse the more I rode.

I’ve ridden lots of mountain bikes throughout my life: cross-country bikes, downhill bikes, patrol bikes, women-specific bikes and unisex bikes. While I’ve encountered saddle discomfort, I have never had an issue that could not be managed. Here I was on my dream bike, made “by women for women”, and for the first time in my life, I was experiencing discomfort to such an extreme that it made me not want to ride.

It occurred to me that if I was hurting, maybe other women were hurting, too. That got me wondering what life would have been like had this issue happened to me on a patrol bike. I couldn’t imagine explaining to my male boss that I couldn’t ride because my cha-cha hurt. Most public safety cyclists don’t get a say in the equipment they are issued, so it’s plausible that a lot of women are suffering in silence. This sent me down a path to learn all I could about bike saddles and the problems they cause for women.

I was shocked to learn that it’s actually quite common for female cyclists to report genitourinary issues caused by their bike saddles. These issues include such things as genital numbness, urinary tract infections, labial hypertrophy (aka swelling), vaginitis, perineal pain, clitoral micro-calcifications, ischial tuberosity (aka seat bone) pain, lymphatic swelling and drainage issues, and saddles sores (including abscesses, infected hair follicles, and chafing).

The scientific community coined the term “bicyclist’s vulva” to describe a condition found in some competitive cyclists in which one side of the labia swells grotesquely 1. In fact, saddle-related problems are so widespread that the cycling community has adopted its own all-encompassing, somewhat crass and yet surprisingly apt term – “flapmash” – to describe it 2.

A 2006 study by Guess, et. al., published in the Journal of Sexual Medicine found that 60% of the female bicyclists in their study reported genital pain, tingling, or numbness within the previous month, which was significantly higher than a control group 3.

Additionally, in 2016, the American Society of Plastic Surgeons reported a 39% jump in labiaplasties, a surgical procedure that literally shaves down the length of the labia minor 4. While much of that jump was attributed to changes in cosmetic preferences, a significant number of those procedures were found to have been among cyclists looking for relief from “flapmash.” In fact, the labiaplasty has become so popular among female cyclists that it has been dubbed “saddle surgery”.

What Gives?

So why are saddles causing problems to such an extent that some women would undergo extreme surgical procedures to alleviate them? The truth is that while there is a lot of conjecture, there actually hasn’t been much scientific research on how women interface with their saddles. What research has been conducted tends to be quite limited in scope. As such, there is a lot we don’t know.

Things Are Different Down There

Most of the research that has been completed on how the saddle affects the body has focused predominantly on men. It doesn’t take a genius to recognize that there are significant differences between the two genders in this area. Some might point to the fact that most saddle-related issues are attributable to compression of the pudendal nerves and arteries, and that these are anatomically the same in both men and women.

However, in a 2014 article in the Journal of Sexual Medicine, Partin, et. al., noted the following: “Literature indicates that there are significant gender-specific anatomical differences that affect how the bodies of women and men interact with the bicycle. Specifically, women have a wider pelvis and a lower center of gravity and demonstrate a greater pelvic tilt when riding. In novel work, Potter, et. al., also identified substantial differences in saddle pressure distribution between male and female riders.” 5

Things Are Even Different Among Women

While over the last two centuries, there has been considerable research on male genitalia, there has been very little scientific research regarding the female form. Only recently has there been a concerted effort to understand what would be considered “normal or average” with regard to the range of measurements of female genitalia.

One study, by Lloyd, et. al., published in 2005 in the International Journal of Obstetrics and Gynaechology 6, suggests that there are significant differences in genital dimensions among women and that there may actually be greater variability amongst women then amongst men. This variance means that the “one-design-fits-all” approach to saddle manufacturing won’t work for women. What’s comfortable for one woman may be a complete nightmare for another. Most manufacturers have adopted the “traditional” women’s saddle design; one with a shorter nose, wider back and centre cutout. This configuration has essentially remained unchanged since the early 90’s, but we know that women require an assortment of saddle options to meet their varied needs.

Science Left Us Behind

To understand the interface between the saddle and rider, the manufacturers, saddle fitters, and researchers rely heavily on pressure mapping; that is, computerized technology that measures how the rider’s weight is distributed across the saddle. While this mapping offers important insights on pressure points, it doesn’t paint an exact picture about what is happening to the rider’s soft tissues.

To expound upon this understanding, men have undergone a host of other tests such as finite element analysis of internal perineal stress, oxygen pressure testing, blood flows of analysis, and even MRI imaging to show how the bike seat compresses the perineum.

Unfortunately, the researchers neglected to include women in almost all of these studies. This has led to the gap in our understanding of how saddles affect female cyclists. As such, pretty much all of the scientific knowledge in this area has been gained by the following tests: pressure mapping, genital vibratory threshold analysis, ultrasonographic/Doppler testing, and good old-fashioned observation. Dr. Andy Pruitt, renowned for the science of bike fit, recently conducted research using a specially-designed, clear women’s saddle. Through this saddle he was able to physically observe what was happening to the genital tissues of fifteen brave souls who rode naked for the experiment 7.

Aside from basic genitalia differences, the shape of the female pelvis also plays a critical role. Research conducted by Potter, et. al., published 2008 in Medicine and Science In Sports and Exercise, found significant differences in saddle pressure distribution between male and female riders. It is hypothesized that much of this is the result of the anatomical differences in the pelvis.8 We know that for both men and women, the goal of the saddle is to support as much of the rider’s weight as possible on the ischial tuberosities (IT’s).

First, it’s important to note that the IT’s are generally wider on women. Also, the female pelvis has a flatter pubic arch versus the male pelvis, leading to a larger subpubic angle. As per Figure 1, on the female pelvis, the arch is usually more “U”-shaped, whereas on the male pelvis, this arch is “V”-shaped. When seated on the saddle, this angle may cause more of the female rider’s weight to rest on the pubic rami rather than the IT’s.

In fact, because the subpubic angle is wider, there is actually a chance that more of the female’ weight will rest as far forward as the pubic symphysis. This in turn can compress the external soft tissues that are located in these areas, such as toward the nose of the saddle. Finally, because the pubic arch is typically shallower and sits lower on women, it means that women’s sensitive soft tissue often comes in contact with the saddle sooner than men’s soft tissue does, leading to more potential areas of constriction. The research of Potter, et. al., strongly suggests that women would benefit from gender-specific saddles, particularly saddles that have a wider posterior region to accommodate the greater IT widths.8

“Tippy Hips” Can Cause Problems

Musculoskeletal imbalances, such as anterior pelvic tilt (APT) can also exacerbate saddle problems. APT is a common condition in which the front of the pelvis rotates forward, while simultaneously raising the back of the pelvis. Women naturally have a more tilted pelvis then men, but there are levels for both genders at which this tilt is considered excessive.

A 2007 study by Sauer, et. al., published in Medicine and Science in Sports and Exercise found that female road cyclists exhibited greater than average pelvic tilt than their male counterparts when performing seated cycling.9 This may be because women tend to experience excessive anterior pelvic tilt more than men, but it could also be because women tend to be more flexible, which can promote pelvic tilt when seated in the saddle. APT can exacerbate saddle problems by driving the rider’s weight down toward the nose of the saddle.

Some Types of Riding Hurt More Than Others

The type of riding plays a significant role in how the saddle affects the rider. Road cyclists who adopt the most aggressive posture on a bicycle tend to report more pain than touring or commuting cyclists who tend to adopt a more upright stance. This is corroborated by research studies that show that when road cyclists adopt the drop handlebar position, they develop higher pressures toward the front of the saddle, causing more of the rider’s weight to rest on the perineum.10

Interestingly, one study found that much more anterior saddle pressure is created when women use the drop bars than when men use them.8 Using this logic, it would stand to reason that mountain bikers would experience the least amount of problems, given that they spend the least amount of time actually seated on the saddle. One must consider, however, that mountain bikers may experience greater terrain-related vibrations that can cause micro-trauma.11

The Design Dilemma

While manufacturers keep devising new ergonomic design “solutions” for saddle pain, it is important to note that many of these “advancements” are not supported by academic research, particularly when it comes to the female anatomy. Before an academic researcher publishes findings in a scientific journal, the study typically undergoes a rigorous peer-review process during which other experts evaluate the researcher’s methods and agree with their findings.

On the other hand, many claims made by manufacturers undergo no such scrutiny. It is likely that these manufacturers do compile research when designing new saddles, and one can appreciate the need for a company to protect its intellectual property. However, since this research isn’t published, it is hard for consumers to distinguish fact from conjecture. As a result, there is a lot of conflicting information, all of which claims to be the result of “research”.

For example, there are currently two different saddle manufacturers whose research justifies their decision to not offer gender-specific saddles. One company suggests that women’s IT’s are not all that much wider than men’s, and the other suggests that because women have smaller pelvises, they don’t actually require wider saddles than men. As noted previously, the academic research is clear: most female riders do benefit from a wider saddle.8

The cutout is another gray area. Many manufacturers claim research demonstrates that the cutout offers relief from perineal pain, whereas others shun the cutout, claiming it places undo pressure on the tissues that rest along the outside of the cutout. New information has emerged suggesting that some women’s labial tissue actually swells while riding, causing it to get sucked into the cutout, thus creating discomfort. Among those manufacturers making this argument, some suggest the length of a women’s labia minora tissue (whether they are an “innie” or an “outie”) may be a factor.

While there have been a few academic studies regarding saddle cutouts, the results are ambiguous. Some suggest the cutout helps perineal issues, while others suggest the cutouts may actually be the cause of problems.12 I was unable to find any academic research that took individual labial or other genital measurements into account.

Considering the wide variance among women’s genitalia, this is an area that could probably stand to be researched, but the truth is right now we simply do not have enough information to draw conclusions. As such, each individual woman will have to find the saddle that works best for her. Saddle fitters can help with IT measuring, but otherwise the search for the right saddle may come down to trial and error.

Part II of Women’s Saddle Pain: When it Comes to Tulips, It’s Not All Roses, will offer advice on ways to alleviate saddle problems.

1 Baeyens L, Vermeesch E, Bourgeois B. “Bicyclists’ Vulva: Observational Study”. The BMJ 2002;325:138–139.

2 Chapelle, E. “The Truth About The Saddle Sore!” 2017 Casquette.co.uk; https://www.casquette.co.uk/know-how/2017/4/22/saddle-lore.

3 Guess MK, Connell K, Schrader S, Reutman S, Wang A, LaCome J, Toennis C, Lowe B, Melman A, Mikhail M, Gential. “Sensation and Sexual Function In Women Bicyclists and Runners: Are Your Feet Safer Than Your Seat?” Journal of Sexual Medicine, 2006; 3; 6;1018-1027.

4 Horton K. “Stats Show Labiaplasty is Becoming More Popular”, Plasticsurgery.org 2017; https://www.plasticsurgery.org/news/blog/stats-show-labiaplasty-is-becoming-more-popular.

5 Partin S, Connell K, Schrader S, Guess M. “Les Lanternes Rouges: The Race for Information About Cycling‐Related Female Sexual Dysfunction”. Medicine and Science In Sports and Exercise, 2014; 11; 8; 2039-2047.

6 Lloyd J, Crouch N, Minto C, Liao L, Creighton S. “Female Genital Appearance: ‘Normality’ Unfolds”, International Journal of Obstetrics and Gynaecology 2005, 112; 5; 643-646.

7 Bastone K. “Specialized's New Saddle Puts Women's Comfort First”, Outside.com, 2019, http://www.outsideonline.com/2398635/specialized-bike-saddles-mimic-women.

8 Potter J, Sauer J, Weisshaar C, Thelen D, Ploeg H. “Gender Differences in Bicycle Saddle Pressure Distribution during Seated Cycling”. Medicine & Science in Sports & Exercise, 2008; 40; 6; 1126-1134.

9 Sauer J, Potter J, Weisshaar C, Ploeg H, Thelen D, Ploeg H. “Influence of Gender, Power, and Hand Position on Pelvic Motion during Seated Cycling”. Medicine & Science in Sports & Exercise, 2007; 39; 12; 2204-2211.

10 Partin S, Connell K, Schrader S, LaCombe J, Lowe B, Sweeney A, Reutman S, Wang A, Toennis C, Melman A, Mikhail M, Guess M. “The Bar Sinister: Does Handlebar Level Damage the Pelvic Floor in Female Cyclists?” The Journal Of Sexual Medicine, 2012; 9; 5; 1367-1373.

11 Battaglia C, Nappi R, Mancini F, Cianciosi A, Persico N, Busacchi P. “Ultrasonographic and Doppler Findings of Subclinical Clitoral Microtraumatisms in Mountain Bikers and Horseback Riders”. The Journal Of Sexual Medicine, 2009; 6; 2; 464-468

12 Guess M, Partin S, Schrader S, Lowe B, LaCombe J, Reutman S, Wang A, Toennis C, Melman A, Mikhail M, Connell K. “Women’s Bike Seats: A Pressing Matter For Competitive Female Cyclists”. The Journal Of Sexual Medicine, 2011; 8; 11; 3144-3153

Image: Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

Liz is a sergeant with the University of Guelph Campus Community Police where she supervises a platoon and oversees the organization’s bike patrol unit. She has been an IPMBA instructor since 2006, was elected to the IPMBA Board in 2018, and is currently serving as Treasurer. A good day for Liz involves a backcountry trail and a cold beer; when she’s not enjoying either she can be reached at ebouchard@police.uoguelph.ca.

IPMBA News