As cycling gains popularity in the female population, there is also a growing interest in and need of more information about the possible effects of cycling on pelvic floor function. From the results of a previously conducted systematic review (1), sexual dysfunction and saddle complaints, such as genital pain and genital numbness, seem to be the most common complaints in female cyclists. However, acquiring more accurate data of these complaints is vital in order to provide women with more qualitative information and ultimately increase awareness and improve women’s health care. Therefore, the aim of this study is three-fold. The primary objective is to identify the prevalence of (i) pain, (ii) swelling of the labia, (iii) numbness/ tingling, and (iv) skin irritation in the genital areas. Moreover, the impact of these complaints on the quality of life, sexual functioning and cycling activities and which actions women undertake to prevent or reduce such complaints will be explored as well. Finally, cycling characteristics, personal habits and gynaecological history will be taken into account to search for possible connections with the complaints.

An observational, cross-sectional study design, approved by the local Ethics Committee, in which an online survey is used, developed by a team of multidisciplinary experts. The survey was presented to and tested by external experts, such as bike fit experts, physiotherapists and (professional) female cyclists. Based on their feedback, the survey was further improved. 
The questionnaire was divided into three main parts. In the first part, demographic data, such as age, weight and number of pregnancies was collected. Moreover, additional questions, for example depilation habits and anatomy of the labia, were added. The second part explored the cycling habits and behaviour of the participants. This included questions about cycling discipline, average distance per week, saddle type, clothing and so forth. In the third, and final, part of the survey, the four main complaints (genital pain, swelling of the labia, genital tingling/numbness and skin irritation) were explored in detail. For instance, participants were asked about the duration, the intensity and the impact of the complaint. For the last two, a slider with a range from 0-10 was used, in which 0 indicated not intense at all/ no burden and 10 indicated severe intensity/ burden. Additionally, participants were asked to state the impact of the complaints on the quality of life, sexual activities and which tools were used to prevent or reduce such complaints. 
Participants were recruited through social media, in collaboration with two women’s health communities, i.e. The Pelvic Floor and The Women Peloton. Additionally, e-mails were sent out to a handful of cycling clubs. Preliminary data was collected from the 16th of February until the 14th of March of 2023. To be eligible for the study, participants were required to be aged 18 years or older and a recreational, competitive or professional female cyclist.

In total, 620 out of 722 participants were eligible for inclusion, with a mean age of 37,4 years old (SD = 11.2) and a mean BMI of 23,7 (SD = 3.7). The majority of participants, or 84,7%, identified as a recreational cyclist, followed by 13,4% identifying as a competitive cyclist and 1,9% as a professional cyclist. Road cycling (n = 557/620), mountain biking (n = 174/620) and gravel (n = 123/620) appear to be the most popular cycling disciplines. 
Preliminary results of the study show that 96% (n = 595/620) of participants has experienced at least one of the complaints that were investigated. The most reported complaint was genital pain (88,9%), succeeded by skin irritation (70,6%), genital tingling or numbness (47,4%) and lastly swelling of the labia (42,4%). Skin irritation and swelling of the labia had the most impact on female cyclists. A score of ≥ 6/10 was given by 68,3% and 54,4%, respectively, which indicates major to severe worrying or burden. As a result of the complaints, about half of the women (n = 298/595) experience sexual dysfunction, such as pain (n = 193/298) and less frequent sexual interaction (144/298). Moreover, 28,1% of women stated they cycle less frequently due to the complaints. When asked about which feelings the complaints evoked, frustration (n = 267/595) and embarrassment (123/595) were the most common.
The final part of the survey shows that women most frequently seek help online (27,7%) or from bike fit experts (19,7%). However, the majority of the participants did not seek help for their complaints (45,2%). The most commonly used measures to prevent or reduce complaints include adjusting posture while cycling (57,3%), wearing padded shorts (55,3%), changing the type of saddle (44,2%) and using chamois cream (39,7%). Of those listed above, changing the type of saddle (78,8%), wearing padded shorts (72,3%) and chamois cream (68,7%) were the most effective. Finally, 60% of the participants indicated they were still experiencing complaints at the current moment.

The main takeaway from this research is that a large proportion of female cyclists appear to experience genital problems, with pain and skin irritation being the most prevalent. However, these findings might be biased: perhaps female cyclists that already experience such complaints were more likely to fill in the questionnaire. The complaints seem to not only have a large impact on mental health and sexual function, but also on cycling activities, as some women tend to avoid their bicycle more due to their problems. Furthermore, as women seem to mainly use the internet in search for solutions, it might be important to consider providing more qualitative information on such mediums in the future, although it remains equally important to encourage women to talk about their problems and to seek help with professionals.

Female cyclists often experience saddle complaints and frequently face barriers in sharing their problems with others. Additionally, genital pain, saddle soreness and skin irritation are the reason why one third of women refrain their favourite physical activities. These complaints have a negative impact on their quality of life and sexual activities. These preliminary data and insights may be useful to break the taboo and increase the awareness and the knowledge about these kind of problems.

D. Van den Stock, L. Van Rompaey, J. Michielsen, T. Van Aggelpoel, H. Neels. 2022. Pelvic floor dysfunction in female cyclists: a systematic review (Unpublished master's thesis). University of Antwerp.

Continence 7S1 (2023) 100913
DOI: 10.1016/j.cont.2023.100913