Health concerns of female cyclists

The health benefits of high volume cycling are endless. But, how much training is too much? In the recent past, Bicyclists’ vulva a condition of female genital parts has seen a rapid increase. The condition was first described by Belgian gynaecologists when they observed it in six high volume (cycling more than 500km per week) cyclists.

Many conditions such as cyclist’s nipple, neuropathic syndrome and many skin conditions caused by saddle have been described for female cyclist athletes. This new condition has been recognided because of problems with the lymph drainage when it comes in contact with the saddle.

This problem was first noticed by doctors they when the patients had unilateral vulval swelling and no other history of lymphedema was present in any case. And their diagnosis of lymph drainage abnormality was diagnosed on lymphoscintigraphy.

Vulval lymphedema may be caused by continuous compression of inguinal lymph nodes due to the posture of cyclists on the saddle and also due to chronic inflammation of vulvo-perineal area.

Symptoms

Usually the cyclists present as unilateral swelling of the genital area with mild pain and discomfort and also it reduces when they are off the saddle.

Pathophysiology

Continuous pressure on the vulva inhibits proper lymph drainage from the inguinal region and inflammation of vulvo-perineal area. Increased saddle time aggravates it. It increases from higher pressure in bent position of cyclists when their back is 40 degrees from horizontal as compared to 60 degrees from horizontal. The type of saddle also may be responsible such as cut out saddle or flat saddle; it has been shown that cut out saddle has more pressure impact on soft tissues as compared to flat saddles.

Clinical diagnosis

This condition is usually diagnosed clinically by proper history taking and examination and ruling out other pre-existing causes such as previous history of lymphedema. This condition should be differentiated from other vulval conditions such as bartholin’s cyst, cellulitis, vulval hematoma, furuncle, soft tissue abscess. Lymphoscintigraphic studies are not advised routinely if clinically there is no doubt, but it is being used in research.

Therapeutic intervention/treatment

• Decreasing the saddle time
• Raising the handle bar which would help increasing the angle of back to horizontal
• More standing during cycling
• Changing the saddle type from cut to flat or flat to cut
• Wearing padded shorts
• Maintaining perineal hygiene
• Elevation of limbs while taking rest which enhances lymph drainage
• Cold compress
• Physiotherapy
• Surgery is rarely required when discomfort increases

By: Dr Vimee Bindra
(The writer is Consultant Gynaecologist and Obstetrician, Apollo Hospitals, Jubilee Hills, Hyderabad)