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Pelvic floor symptoms in female cyclists and possible remedies: a narrative review

  • Review Article
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Abstract

Introduction and hypothesis

Cycling has become a popular athletic activity worldwide and can lead to genital and pelvic floor dysfunction. This review summarizes the current body of evidence about the epidemiology of genital and pelvic floor symptoms in female cyclists, the therapy, and preventive interventions.

Methods

Two electronic meta-databases, OvidSP™ and Deutsches Institut für Medizinische Dokumentation und Information (DIMDI), comprising 40 individual databases, were searched for studies that described genital and pelvic floor symptoms in association with cycling and studies that tested possible therapies and prophylactic measures. For the literature search we explored the search terms “female”, “bicycling”, “pelvic floor”, “lower urinary tract symptoms”, and “vulvar diseases”.

Results

The search retrieved 1,219 articles, leaving 763 articles after removal of duplicates, and finally 12 articles eligible for review. We assessed 10 observational and 2 experimental studies. Genital and pelvic floor symptoms related to bicycling were pain, tenderness, neuropathy, urological dysfunction and skin lesions. Broader and conventionally shaped saddles were associated with fewer symptoms compared with cut-out saddle designs.

Conclusion

The quality of existing studies is generally low, but there is evidence that female cyclists suffer from similar problems to male cyclists, ranging from minor skin lesions to severe sequelae such as pain and neurological deficiencies.

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References

  1. Johan de Hartog J, Boogaard H, Nijland H, Hoek G (2010) Do the health benefits of cycling outweigh the risks? Environ Health Perspect 118(8):1109–1116. doi:10.1289/ehp.0901747

    Article  PubMed  Google Scholar 

  2. Warburton DE, Nicol CW, Bredin SS (2006) Health benefits of physical activity: the evidence. CMAJ 174(6):801–809

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bundesministerium für Verkehr (2013) Radverkehr in Zahlen—Daten, Fakten und Stimmungen. BM für Verkehr, Innovation und Technologie; p 109. http://www.bmvit.gv.at/service/publikationen/verkehr/fuss_radverkehr/downloads/riz201503.pdf. Accessed 3 April 2015

  4. Bundesministerium für Verkehr (2013) Radverkehr in Zahlen—Daten, Fakten und Stimmungen. BM für Verkehr, Innovation und Technologie; p 280. http://www.bmvit.gv.at/service/publikationen/verkehr/fuss_radverkehr/downloads/riz201503.pdf. Accessed 3 April 2015

  5. Baker L (2009) How to get more bicycles on the road: to boost urban bicycling, figure out what women want. Scientific American. http://www.scientificamerican.com/article/getting-more-bicyclists-on-the-road/. Accessed 3 April, 2015

  6. Bueler R, Pucher J (2012) Walking and cycling in Western Europe and the United States: trends, policies, and lessons. transportation research news, no. 280, pp 34–42. http://onlinepubs.trb.org/onlinepubs/trnews/trnews280WesternEurope.pdf. Accessed 3 April 2015

  7. Leibovitch I, Mor Y (2005) The vicious cycling: bicycling related urogenital disorders. Eur Urol 47(3):277–86

    Article  PubMed  Google Scholar 

  8. Sommer F, König D, Graft C, Schwarzer U, Bertram C, Klotz T, Engelmann U (2001) Impotence and genital numbness in cyclists. Int J Sports Med 22(6):410–3

    Article  CAS  PubMed  Google Scholar 

  9. Nayal W, Schwarzer U, Klotz T, Heidenreich A, Engelmann (1999) Transcutaneous penile oxygen pressure during bicycling. BJU Int 83(6):623–625

    Article  CAS  PubMed  Google Scholar 

  10. Breda G, Piazza N, Bernardi V, Lunardon E, Caruso A (2005) Development of a new geometric bicycle saddle for the maintenance of genital-perineal vascular perfusion. J Sex Med 2(5):605–611

    Article  CAS  PubMed  Google Scholar 

  11. Frauscher F, Klauser A, Hobisch A, Pallwein L, Stenzl A (2001) Subclinical microtraumatisation of the scrotal contents in extreme mountain biking. Lancet 357(9249):74

    Google Scholar 

  12. Lowe BD, Schrader SM, Breitenstein MJ (2004) Effect of bicycle saddle designs on the pressure to the perineum of the bicyclist. Med Sci Sports Exerc 36(6):1055–1062

    Article  PubMed  Google Scholar 

  13. Schwarzer U, Sommer F, Klotz T, Cremer C, Engelmann U (2002) Cycling and penile oxygen pressure: the type of saddle matters. Eur Urol 41(2):139–143

    Article  PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. doi:10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  15. Battaglia C, Nappi RE, Mancini F, Cianciosi A, Persico N, Busacchi P (2009) Ultrasonographic and Doppler findings of subclinical clitoral microtraumatisms in mountain bikers and horseback riders. J Sex Med 6(2):464–468. doi:10.1111/j.1743-6109.2008.01124.x

    Article  PubMed  Google Scholar 

  16. Weiss BD (1985) Nontraumatic injuries in amateur long distance bicyclists. Am J Sports Med 13(3):187–192

    Article  CAS  PubMed  Google Scholar 

  17. Keytel LR, Noakes TD (2002) Effects of a novel bicycle saddle on symptoms and comfort in cyclists. S Afr Med J 92(4):295–2958

  18. Guess MK, Connell K, Schrader S, Reutman S, Wang A, LaCombe J, Toennis C, Lowe B, Melman A, Mikhail M (2006) Genital sensation and sexual function in women bicyclists and runners: are your feet safer than your seat? J Sex Med 3(6):1018–1027

    Article  PubMed  Google Scholar 

  19. Khoder W, Hale D (2014) Pudendal neuralgia. Obstet Gynecol Clin N Am 41(3):443–452. doi:10.1016/j.ogc.2014.04.002

    Article  Google Scholar 

  20. LaSalle M, Salimpour P, Adelstein M, Mourtzinos A, Wen C, Renzulli J, Goldstein B, Goldstein L, Cantey-Kiser J, Krane RJ, Goldstein I (1999) Sexual and urinary tract dysfunction in female bicyclists. J Urol 161:269

    Google Scholar 

  21. Guess MK, Partin SN, Schrader S, Lowe B, LaCombe J, Reutman S, Wang A, Toennis C, Melman A, Mikhail M, Connell KA (2011) Women’s bike seats: a pressing matter for competitive female cyclists. J Sex Med 8(11):3144–3153. doi:10.1111/j.1743-6109.2011.02437.x

    Article  PubMed  PubMed Central  Google Scholar 

  22. Partin SN, Connell KA, Schrader S, LaCombe J, Lowe B, Sweeney A, Reutman S, Wang A, Toennis C, Melman A, Mikhail M, Guess MK (2012) The bar sinister: does handlebar level damage the pelvic floor in female cyclists? J Sex Med 9(5):1367–173. doi:10.1111/j.1743-6109.2012.02680.x

    Article  PubMed  PubMed Central  Google Scholar 

  23. De Rose AF, Giglio M, De Caro G, Corbu C, Traverso P, Carmignani G (2001) Arterial priapism and cycling: a new worrisome reality? Urology 58(3):462

    Article  PubMed  Google Scholar 

  24. Gebreegziabher Y, Marcos E, McKinon W, Rogers G (2004) Sperm characteristics of endurance trained cyclists. Int J Sports Med 25(4):247–251

    Article  CAS  PubMed  Google Scholar 

  25. McElhinney BE, Horner T, Dinsmore WW, Harper A, Goldsmith C, Maw RD (1993) Exercise bicycle-induced bilateral vulval abscesses. Int J STD AIDS 4(3):174–175

    CAS  PubMed  Google Scholar 

  26. Baeyens L, Vermeersch E, Bourgeois P (2002) Bicyclist’s vulva: observational study. BMJ 325(7356):138–139

    Article  PubMed  PubMed Central  Google Scholar 

  27. Humphries D (2002) Unilateral vulval hypertrophy in competitive female cyclists. Br J Sports Med 36(6):463–464

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. McCluggage WG, Smith JH (2011) Reactive fibroblastic and myofibroblastic proliferation of the vulva (Cyclist’s nodule): a hitherto poorly described vulval lesion occurring in cyclists. Am J Surg Pathol 35(1):110–114. doi:10.1097/PAS.0b013e3181ffd8ab

    Article  PubMed  Google Scholar 

  29. Weiss BD (1993) Skin cream for alleviating seat pain in amateur long-distance bicyclists. Sports Med Train Rehabil 4:27–32

    Article  Google Scholar 

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Conflicts of interest

W. Umek has received research grants and speaker honoraria from Pfizer, Astellas and Innovacell; E. Hanzal has received research grants and speaker honoraria from Pfizer, Johnson & Johnson and Astellas.

Funding

This review was funded by the Karl-Landsteiner-Gesellschaft, Franziskanergasse 4a, 3100 St. Pölten, Austria.

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Correspondence to Marie-Louise Trofaier.

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Trofaier, ML., Schneidinger, C., Marschalek, J. et al. Pelvic floor symptoms in female cyclists and possible remedies: a narrative review. Int Urogynecol J 27, 513–519 (2016). https://doi.org/10.1007/s00192-015-2803-9

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  • DOI: https://doi.org/10.1007/s00192-015-2803-9

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