Getting to the Bottom of Saddle Sores: A Scoping Review of the Definition, Prevalence, Management and Prevention of Saddle Sores in Cycling

Abstract

Objectives: To summarise and map the existing evidence relating to the definition, prevalence, prevention and management of saddle sores within the literature and highlight research gaps. Design: Scoping review. Data Sources: Three databases were searched using an appropriate search strategy agreed on by the authors with the aid of an experienced medical librarian; these databases were MEDLINE, EMBASE and Web of Science. Eligibility Criteria: To be included in this review, studies must have made specific reference to dermatological conditions that affect the saddle area, specifically arising from cycling, in either sex. Results: Seventeen studies were selected for inclusion. Saddle sores in males were the focus of thirteen studies, with only two reporting in females. Saddle sores were defined as connective tissue lesions affecting the skin in the saddle area, which can be both acute and chronic. Commonly cited preventions were chamois cream, high quality, well-fitting cycling equipment and good personal hygiene. Management in the early stages usually involves rest. Topical and intralesional steroids and lubricating creams are recommended treatments for small saddle sores, with surgical excision an option for larger, persistent saddle sores. However, surgery and steroid use may increase risk of recurrence. Conclusions: Saddle sores are an underrepresented, male-dominated issue within the literature. There is particularly limited evidence around treatment options, including topical steroids and surgical removal. Further well-designed observational studies and/or randomised controlled trials will help provide further evidence on prevalence, prevention and treatment available in the future.

Vulval symptoms in female recreational cyclists

“…11 Initially redness, chafing, pain, loss of sensation and folliculitis, and developing into ulceration and chronic unilateral swelling of the labia majora "bicyclist's vulva". 2,3,9,12 A 2022 systematic review into the prevalence of saddle sores reported them almost exclusively to be in males, however, the author accepts that this likely represents publication bias. 2 We have demonstrated that actually saddle sores are a significant problem in female cyclist.…”

“…2,3,9,12 A 2022 systematic review into the prevalence of saddle sores reported them almost exclusively to be in males, however, the author accepts that this likely represents publication bias. 2 We have demonstrated that actually saddle sores are a significant problem in female cyclist. Effective management of early symptoms may prevent the more significant symptoms developing that potentially require surgical management.…”

“…Using a high-quality saddle with adequate cushioning is frequently reported as a preventative measure for saddle sores. 2,3,[13][14][15] Both the existing literature and women in our questionnaire suggested that more research is required on women specific saddles and how they influence genital pressures, sensation and pelvic floor symptoms. 16 Participants reported benefits from having professional bike fits.…”

“…One review found using chamois cream as a lubricant was the most commonly cited method of prevention of saddle sores. 2 Cycling groups also advice the use of lubricating chamois cream to reduce friction and the associated complications. 15 There is a wide range of different creams and lubricants, some with anti-fungal, anti-bacterial or steroid properties.…”

“…The effect of cycling on women's vulva and perineum is underrepresented in the literature compared to research on the effect of cycling on male anatomy. 2 Small studies, usually case studies, and reviews have focused on female competitive cyclists, 3 but to our knowledge there is very little research on recreational cyclists. Elite athletes have a mean age in the mid-thirties, and do not represent the prevalence and management of cycling related vulval pathology in the general cycling population, which includes perimenopausal and menopausal women.…”