Despite the fact that cycling gains popularity in women, for recreational as well as competitive purposes, there is little awareness and/or knowledge among this population around pelvic floor dysfunctions and its potential impact on the quality of life. The prevalence and the causes of pelvic floor disorders in male cyclists have been described in recent studies. The most common symptoms are, for instance, genital numbness and erectile dysfunction. However, little is still known about the effects of cycling on female cyclists’ pelvic floor. In an attempt to provide an overview of the prevalence of pelvic floor dysfunctions in female cyclists, this study will present an extensive review of the current literature. Additionally, this study explores the possible influencing factors and the impact of female cyclists’ complaints on their quality of life.

A systematic review was conducted and reported according to the PRISMA-guidelines. Two databases were consulted, namely PubMed and Web of Science. The search strategy consisted of a combination of the search terms ‘female cyclists’ and ‘pelvic floor dysfunctions’. Alternative and related terms, such as ‘incontinence’, ‘pain’, ‘sexual dysfunction’, ‘constipation’ and ‘quality of life’ were also employed. Each article was blindly screened for eligibility by two independent researchers. Initially based on the article’s title and abstract and, subsequently, based on the full contents. Moreover, the articles were screened for risk of bias using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. The relevant results for the current study were extracted and summarised in an evidence table.

In total, eleven cross-sectional studies were included in the review. A total of 4.711 female cyclists participated across these studies, ranging from recreational and professional cyclists, to road cyclists and mountain bike cyclists. Genital pain (69%), genital numbness (47%) and sexual dysfunction (55,5%) were the most common reported complaints. Genital numbness and genital pain have moreover been proven to induce a higher risk of sexual dysfunction (p < 0,05). The systematic review also shows, for instance, that genital numbness mainly occurs in the labia (81%), followed by the vulva (70%), buttocks (16%) and perineum (10%). Furthermore, a higher BMI (OR: 1.04, 95% CI, 1.01 − 1.08, p = .02) and a history of UTI (OR: 1.48, 95% CI, 1.17 − 1.96, p = .007) increases the chance of numbness (1). The odds of reporting genital pain were higher when participants cycled more than 10 hours per week (OR: 2.4, 95% CI, 1.1-5.2, p = .03) (2). Finally, numerous studies demonstrate that the type of saddle or handlebar height influences the prevalence of pelvic floor dysfunctions in different ways. One study, for example, reported higher odds of urogenital disorders (dysuria: OR: 2.41, 95% CI, 1.20-4.85, p = .01; straining to void: OR: 3.31, 95% CI, 1.33-8.19, p = .01) with increasing saddle width (3).

In sum, the most frequently reported pelvic floor dysfunctions include genital pain, genital numbness and sexual dysfunction. However, these were also the most frequently questioned dysfunctions. In contrast, only two out of eleven studies investigated urogenital disorders (e.g. urinary incontinence or dysuria) related to cycling, which makes it difficult to draw strong conclusions. The systematic review also indicates the potential impact of bicycle setup, but this factor remains to be further investigated in future research. Although this was anticipated, information concerning the prevalence of bowel-related pelvic floor dysfunctions (e.g. fecal incontinence or constipation) and its effect on the quality of life has not yet been described. The same holds for pregnancy and childbirth as possible influencing factors for the development of pelvic floor dysfunctions in female cyclists. Finally, it has to be emphasized that in some studies the number of participants was rather low, which makes it difficult to make strong generalisations to the broader female cyclist population.

While it is unfortunate that urogenital and bowel-related complaints were less investigated, it is conceivable that these types of complaints are perhaps less relevant for this population. Therefore, it might be more important to acquire more accurate data of the current most commonly known and reported complaints, such as genital pain and genital numbness, in order to further improve the awareness and/or knowledge and to be able to break the taboo. Moreover, future research should take into consideration (i) the impact of the complaints on the quality of life, and (ii) childbearing and gynaecological history as possible influencing factors for pelvic floor dysfunctions.

Lui, H., Mmonu, N., & Awad, M. (2021). Association of Bicycle-Related Genital Numbness and Female Sexual Dysfunction: Results From a Large, Multinational, Cross-Sectional Study. Journal of sexual medicine, 9.
Greenberg, D., Khandwala, Y., & Breyer. (2019). Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists. The journal of sexual medicine, 16, 8.
Hermans, T., Wijn, R., & Winkens, B. (2016). Urogenital and Sexual Complaints in Female Club Cyclists—A Cross-Sectional Study. J Sex Med, 13(5).