We Need to Talk About Women’s Bike Fit Issues

“Doesn’t your bum get sore sitting on that seat?” Every cyclist has been asked this question at some point, usually by a passerby or fellow latte sipper at the local coffee spot. Cyclists typically respond with a bit of a laugh and something along the lines of, “It’s not as bad as it looks” or “That’s why we wear padded shorts” before getting back to sipping macchiatos and discussing Strava segments.

But if we were to be honest when asked about saddle comfort, many of us would say, “Yes, my bum does hurt sitting on that seat…until the numbness kicks in”.

As a professional bike fitter of close to 20 years, I’ve helped countless cyclists resolve their saddle-related bike fit issues.

Some presentations are straightforward and require a simple fix. Other complaints are more challenging and require more creative problem-solving.

I’ve worked in this space for long enough to know how common saddle discomfort is for cyclists and that many riders simply put up with symptoms, believing that saddle sores and a bit of genital numbness are just part and parcel of being a cyclist.

That is until symptoms escalate to things like painful urination, recurrent skin infections, or saddle problems begin to affect the rider’s sex life. That’s when riders start booking bike fit assessments with people like me.

Unfortunately, not a great deal gets written about saddle-related bike fit issues in women. It’s a topic that many male bike-fit professionals may feel uncomfortable writing about.

With so few female bike fitters in the industry, I’ve written this article to shed light on some common and not-so-common bike fit issues that women disproportionately suffer from.

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WOMEN’S BIKE FIT ISSUES: HOW COMMON ARE THEY?

Female cyclists are much more likely to suffer from bike fit-related injuries or conditions than men.

Cyclists spend prolonged periods sitting in postures that can place up to 40% of the individual’s body weight onto delicate pelvic tissues, including the perineum, vulva, pubic bones, and clitoris.

These tissues were not designed to bear weight for prolonged periods, so it is not surprising that a study published in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology found that 44% of female cyclists have experienced vulval or perineal pain that deterred them from cycling.

The incidence of saddle-related pain for professional cyclists is even higher.

One study on British professional cyclists found that nearly 100% of female athletes suffered saddle-related injuries that negatively affected their training and competition. Researchers also discovered that despite saddle-related injuries being so common, most female cyclists don’t seek help resolving their issues often because they feel uncomfortable bringing the issues up to team support staff, who are primarily men.

This reluctance to seek help is unsurprising but highlights some of the issues women face participating in a sport and industry that has traditionally been very male-dominated.

As women’s cycling grows in popularity, some medical practitioners have noticed more female cyclists attending gynaecological clinics with cycling-related injuries; at times, the injuries are severe enough to prevent patients from riding.

A 2023 study published by Lizzie Harrison and Katharine Edey found that 37% of female cyclists suffer from saddle-related pain, 33% have chafing, 27% experience skin irritation, and 20% of female recreational cyclists experience infections attributed to cycling.

We know that these problems are common, and many cyclists avoid seeing a bike fitter or health professional to address them.

This is concerning because riding through pain in the pelvic region can have detrimental long-term health consequences.

Moreover, it’s also far from ideal if riders are forced to give up on cycling as a sport or form of exercise.

We want to see more women enjoying the sport of cycling, not less.

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SADDLE RELATED PROBLEMS FOR FEMALE CYCLISTS

So, what sort of problems are we talking about?

Here are some saddle-related issues that female cyclists and their support teams should be aware of.

Perineal nodular induration (PNI)Also known as biker’s nodule or ischial hygroma, perineal nodular induration is a benign pseudotumor that usually develops on the vulva or perineum. Poorly recognised and underdiagnosed in female athletes, PNI may be caused by macrotraumatic injury or repetitive microtrauma to the skin and subcutaneous fascia that contacts the saddle. The nodules that develop can vary in size and elicit pain and discomfort if excessive pressure is received through the saddle. Some cyclists have presented with labial nodules up to 60mm in diameter.

Some riders require surgical intervention to remove the nodule. Yet, others can find comfort conservatively with equipment or position changes made to the bike.

If you suspect you are suffering from labial or perineal nodules, make sure you discuss the issue with a medical practitioner.

Folliculitis

Folliculitis, the inflammation of a hair follicle, is a widespread complaint in both men and women. It is often due to prolonged contact or friction with a bike seat.

Based on my experience, riders will suffer from folliculitis in one of three areas. Close to an ischial tuberosity on one or both sides, unilaterally in the fold of the groin, or centrally at the perineum.

Various factors increase your risk of developing folliculitis, but maintaining good personal hygiene is fundamental to staving off the condition. Keeping the skin clean and dry can help, so try not to sit in your sweaty bike shorts for too long after exercising.

Pubic hair removal also increases the risk of folliculitis. Riders who use a razor to remove hair increase their risk significantly. Limiting hair removal is the best option for riders to avoid this condition.

Using good-quality cycling shorts can make a difference here. It is also essential to ensure you don’t wear underwear beneath your bike shorts (one survey showed that about 20% of women wear underwear when cycling).

It’s also worth noting that applying cycling-specific chamois cream directly to the skin significantly reduces the incidence of folliculitis.

Folliculitis can progress to deep skin infections and abscesses in some athletes. Hence, it needs to be taken seriously.

Labial hypertrophy

Sometimes referred to as ‘bicyclist’s vulva’, this is an uncommon presentation in the general population but is prevalent in competitive cyclists.

Labial hypertrophy is an underreported condition where the labia become chronically enlarged and elicit pain from direct saddle pressure.

Sometimes seen alongside folliculitis, skin infection or intra-vulval hematoma, once developed, labial hypertrophy tends to persist even after other symptoms have subsided. For example, suppose a skin infection has contributed to labial tissue thickening. In that case, the structural changes to the labia usually remain even after the skin infection has resolved.

Persistent saddle pressure on the vulva may contribute to labial hypertrophy. Some studies show that pressure can compromise lymphatic circulation to the perineal and vulva, predisposing the tissue to develop hypertrophy .

Saddle choice can be problematic for women with this condition.

Despite much of the bike fit literature highlighting the benefits of saddles with central cut-outs, it is common for riders with this issue to have discomfort if the seat central cut-out is too small or has a relatively sharp edge.

Labial hypertrophy usually presents unilaterally, but riders and bike fitters should be aware that experts consider bilateral hypertrophy underdiagnosed as symmetrical development is much harder for clinicians to identify.

Genital numbness

Loss of sensation to the vulva is another common complaint that up to 58% of female cyclists experience.

Studies that have examined neuropathies highlight that younger cyclists are more likely to experience genital numbness, particularly if they ride road bikes, use narrow saddles, or have handlebars set in a low position. Riders with a high body mass index (BMI) are also more likely to suffer numbness, as body weight directly influences saddle pressure, increasing the risk of pudendal nerve compression.

Cycling-related genital numbness in females can be relatively brief or persist for up to an hour after riding.

Saddle shape, positioning and riding posture are all factors that need to be considered when trying to alleviate genital numbness.

Urinary conditionsUrinary tract infections, cystitis, dysuria, and incontinence are also issues that female cyclists are more likely to experience compared to non-cyclists.

There are several factors thought to contribute to this increased risk for cyclists.

Pain or passing blood when urinating are red flags that shouldn’t be ignored, and riders should seek medical advice if noticing these symptoms. The personal hygiene practices mentioned earlier are wise to follow, but women should avoid vaginal douching as this can increase the risk of developing infections.

Low back pain

Often overlooked as a cause of low back pain in cyclists, a poorly designed or positioned saddle can affect how riders sit on the bike and increase strain on the lower back.

For instance, if a rider has a saddle design that places excessive pressure through the vulva, they may sit with a more upright pelvic position as they subconsciously try to shift weight onto the ischial tuberosities. This then forces the lumbar spine into a flexed position as the rider reaches forward to the handlebars, eliciting pain when riding at high intensities.

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PREVENTING SADDLE-RELATED ISSUES

As with all things in health, prevention is always better than a cure.

Riders can take several steps to reduce their risk of developing saddle-related bike fit issues.

Saddle Design

Female pelvises are generally wider than males.

This is one of the reasons that female-specific saddles are now commonplace in the market.

Women's saddles tend to be broader to support wider sit bones, and they often have central cutouts to reduce perineal and vulval pressure.

Nevertheless, many women still struggle to find saddles that suit their anatomy.

Saddle choice is highly personal, and there is no sure-fire way of selecting a saddle and knowing if it will work for you.

Many brands have saddle selection devices or systems, but in my experience, many of these are often designed to promote retail sales and are ineffective in guiding comfortable saddle choices.

For most women, I recommend avoiding narrow saddles, especially those with the highest point at the centre of the seat.

Saddles with less of a convex profile tend to reduce perineal pressure.

Excessive padding on a seat can reduce pressure on the pelvic bones but tends to increase pressure in the perineum and vulva.

For women who experience chafing on the inside of their thighs, look for saddle shapes with a narrow nose rather than those that don’t give the thighs enough clearance when pedalling.

Riding Position

More aggressive riding postures tend to increase the risk of saddle issues, especially if the handlebars are much lower than the saddle.

Upright riding positions are often required to get women back riding if they have suffered severe pain or discomfort. There is no point riding in a super-aero position if it causes injury or extreme discomfort.

A cockpit reach-length that is excessively long or short can also negatively influence saddle pressure, as can the size and shape of handlebars.

If the saddle is set too high, it increases pressure between the rider and saddle. If the saddle is too low, overall pressure can be reduced, but pelvic instability can ensue, causing excessive friction if the pelvis hikes at the top of each pedal stroke.

If riders and bike fitters are struggling to find the sweet spot between high and low, inadequate crank length may be contributing to discomfort.

Fore-aft adjustment of the saddle also affects saddle pressure.

If the saddle is too far behind the bottom bracket, more pressure is generally felt through the perineum as the rider rolls the pelvis anteriorly or slides forward onto the nose of the saddle.

If the saddle is placed too far forward, riders are more likely to experience friction between the outside edges of the saddle and the inner thighs.

Angling the saddle down slightly can reduce anterior and central saddle pressure. However, if the saddle angle is nosed down excessively, perineal and vulval pressure will increase as gravity slides the rider onto a narrower section of the saddle.

Another problem that I come across regularly is saddles that are pointing to the left or the right. Only in exceptional instances will not want a saddle to be pointing straight ahead.

Hygiene and hair removal

Sweating is unavoidable when cycling, but the warm, moist environment that is a pair of bike shorts can increase the risk of infections if you are not careful.

Always ride in clean knicks and endeavour to shower soon after riding if you are prone to saddle sores or infection.

Vaginal douching with certain feminine hygienic products can be counterproductive as it removes healthy bacteria, leaving you more susceptible to infections.

As mentioned, limiting pubic hair removal should be considered when trying to prevent or recover from conditions like folliculitis or infection.

Don’t wear undies under your shorts

Bike shorts are specifically designed to be worn without underwear. This seems like common sense to most riders, but for a variety of reasons many cyclists still choose to wear undies beneath their bike shorts which creates more irritation to the skin.

Do wear chamois crème

The only thing that should sit between your skin and your bike shorts is chamois crème. Various options are available in the market, some unisex and others targeted at women. Most are water-based and help to reduce friction on the skin. Thicker oil-based options can be helpful when riding in wet conditions or for heavy sweaters.

Anabolic Agents

This won’t be an issue for most cyclists, but it should be considered for professional and aspiring elite cyclists who may be exposed to banned substances.

Some anabolic agents used by athletes to enhance athletic performance can cause clitoral enlargement, increasing the risk of pain and discomfort, particularly for riders who sit in an aggressive riding position.

Seek out a cycling coach

Most accredited cycling coaches will have at least a basic understanding of bike fit fundamentals. Additionally, coaches can be valuable in helping improve riding technique and developing training programs that prevent overtraining, illness and injury.

Get a bike fit

If you have never had a professional bike fit, getting an assessment from an experienced fitter, preferably one with a sports or health science background, is recommended.

If possible, avoid fitters strongly aligned with particular bike or saddle brands, as they may be limited in their product recommendations if the best option for you is not a product they sell.

Some bike fitters are now using saddle pressure mapping equipment, which can be helpful for riders who have experienced persistent saddle-related issues. Unfortunately, few professional fitters in Australia are currently utilising this equipment.

Speak to your doctor

It is essential that you speak to your doctor if you are suffering from saddle-related issues.

Most of the time, medical intervention is not required.

However, many times, riders will need a course of antibiotics or other treatment to alleviate their symptoms and prevent them from worsening.

Surgical intervention is sometimes warranted, especially for professional athletes whose livelihoods depend on being able to train hard and perform well.

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SUMMING UP

Saddle-related pain and discomfort are common experiences for female cyclists. Some conditions may seem relatively minor to begin with but can progress into more severe conditions, some of which lead to permanent structural changes to the labium, clitoris, and perineum.

Young females are at a higher risk of developing these complaints, so it is essential that we raise awareness about the factors that contribute to their development and what can be done to help when problems arise.

Bike fitting can be valuable if riders have access to an experienced fitter.

Still, many riders will face barriers that prevent them from seeking help, such as cost, location, and a lack of female practitioners. I hope this article can drive more discussion and awareness of women’s bike fit issues because, ultimately, we want to see more women enjoying the sport of cycling because cycling is awesome.

Please share this article with anyone who might find it helpful.