Urogynecological, neurological, and psychosexual consequences of cycling in women: a narrative review of compressive pathomechanisms and preventive strategies

Abstract

Background. Despite the growing popularity of cycling among women, pelvic urogynecological and neurological injuries remain an under-researched issue in medical literature, which has historically favored male anatomy. Equipment designed without considering female biomechanics generates pathological compression of perineal tissues.

Aim. This review aims to synthesize evidence on the pathomechanisms of structural vulvar injuries, pudendal nerve compression, and psychosexual dysfunction in female cyclists, and identify preventive strategies based on biomechanical interventions (bike-fitting).

Materials and methods. A systematic literature review of PubMed and PMC databases was conducted. Applying rigorous inclusion criteria (full-text articles, English language, and thematic relevance encompassing female anatomy and biomechanical analyses), 20 peer-reviewed articles were qualified for the final synthesis.

Results. Biomechanical and clinical evidence demonstrates that inadequate saddle width and low handlebars force an anterior pelvic rotation, which drastically increases pressure on perineal soft tissues. This results in a higher incidence of chronic labial lymphedema (bicyclist's vulva) and pudendal nerve compression. While showing no higher rate of overall urinary tract dysfunction compared to other athletes, an increased susceptibility to urinary tract infections (UTIs) has been demonstrated. Furthermore, this compression leads to neuropathy manifesting as a loss of clitoral vibratory sensation, abrasions, and chronic genital pain, which directly contributes to dyspareunia and female sexual dysfunction (FSD).

Conclusions. Equipment individualization through professional bike-fitting (saddle parameters and bicycle geometry) and medical education are crucial for preventing compression injuries. This issue necessitates a multidisciplinary approach to diagnose and treat intimate ailments and psychosexual health in female cyclists.