Urogenital Overuse Injuries In Elite/Professional Cyclist With Labia/Vulvas

Less is known about urogenital overuse injuries and pelvic/perineal health in cyclists with labia/vulvas than in cyclists with testicles/penises. The pelvis/perineum is one of the main weight bearing surfaces during cycling. Prevalence of saddle sores, pain, abrasions, decreased sensation, and “cyclist vulva” (soft tissue swelling) have been assessed but in amateur or recreational riders with a variety of cycling positions/bikes and hours spent in the saddle. Solutions offered include wider saddles, a more upright position, and less time spent cycling, but these don’t meet the needs of professional road cyclists who spend long hours in the saddle with low handlebar heights and pressure forward on the pelvis. Taking time away from cycling is often not an option as it would impact training and race results. PURPOSE: To survey elite cyclists with labia/vulvas to better understand the prevalence of urogenital overuse injuries in this population. METHODS: A novel mixed methods survey with urogenital overuse injury-related questions about pain, numbness, abrasions, ulcerations, folliculitis, abscesses, and non-infected swelling was developed. Questions were tailored to capture issues unique to athletes who rely on cycling as part of their career. Surveys were distributed via The Cyclist Alliance, a union for professional road cyclists with approximately 200 members, with an option for forwarding the link to the survey. RESULTS: 16 eligible riders were included in this descriptive analysis. All had pain with riding, most (>80%) had issues with abrasions, ulcerations, abscesses and non-infected swelling that impaired their training, and in the case of pain, ulcerations, and abscesses, their racing performance. Over half reported a prior bike fit that contributed negatively to their saddle health; most (>90%) felt like their labia “got in the way” while cycling; and there was a trend towards thinking their chamois was the biggest contributor to their saddle health. CONCLUSIONS: In a volunteer sample, urogenital overuse injuries were common and had a negative impact on training and racing. More research with a larger sample size is needed to determine the true prevalence and impact of the subjective experience of urogenital overuse injuries among elite/professional cyclists is needed.