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A Tremback-Ball1, M Gibbons1
1Misericordia Unviersity, Physical Therapy, Dallas, United States
Background: Some female athletes are at risk for developing urogenital issues due to prolonged periods of intense athletic training. Research on cycling has shown that sitting for prolonged periods on a bicycle seat can lead to injury of the perineum and compression of the nerves that provide innervation to the pelvic floor in both females and males. Symptoms range anywhere from minor skin lesions related to chafing to chronic pain/numbness of the perineum and dyspareunia. These conditions may become persistent and can develop into chronic pelvic pain and urogenital dysfunction. Some research has looked at seat design as a way of reducing urogenital dysfunction. Variations in seat design alter the distribution of pressure in the perineum. In athletes training for extended periods, pudendal nerve entrapment may occur. It is important to consider cycle seat style and set-up as a potential association with urogenital and sexual dysfunction.
Purpose: The purpose of this study was to examine the relationship between seating set-up and the development of urogenital and sexual dysfunction in elite triathletes. A second purpose was to examine the prevalence of urogenital and sexual dysfunction in this population.
Methods: Athletes participating in the Ironman Triathlon World Championships were interviewed to collect data on training intensity, cycle set-up, seat type, and symptoms of urogenital and sexual dysfunction.
Results: One hundred fifty women participated in the study. The range of time in the saddle was 7 to 15+ hours per week with 19.46% of participants averaging over 15 hours. It was found 41.41% reported urinary symptoms and 20.67% reported dyspareunia. In multivariate logistic regression analysis, saddle angle was significantly associated with symptoms of generalized urogenital dysfunction (p<.05). Saddle width, saddle shape and handlebar height were not found to be predictors.
Conclusion(s): Prevalence of urinary symptoms was in line with studies in other women. However the prevalence of dyspareunia was higher than typical for other women. The population prevalence is estimated to vary from 3 to 18% globally while this study found a prevalence of 20.67%. This is an indicator that saddle pressure on the perineum may increase one’s risk of developing sexual dysfunction. Cycle set-up may be a means of decreasing this risk. Women who set up their seat with the nose of the saddle angled up were more likely to experience urogenital dysfunction in this study.
Implications: In addition to suggesting that more research is indicated, the researchers suggest health care practitioners can educate themselves on impact of cycling on the pelvic floor. Physical therapists can and should apply this knowledge in their practice of treating female athletes. Incorporating an ergonomic evaluation of the cycle set-up into a plan of care can help therapists to determine best set-up based on based on known risk for injury. Therapists can also educate patients on prevention and identifying signs and symptoms of pelvic floor disorders such as urinary incontinence, pelvic pain and dyspareunia related to distance cycling.
Funding, acknowledgements: none
Keywords: women's health, urogenital dysfunction, sexual dysfunction
Topic: Pelvic, sexual and reproductive health
Did this work require ethics approval? Yes
Institution: Misericordia University
Committee: Misericordia University IRB
Ethics number: IRB-2019-0085
All authors, affiliations and abstracts have been published as submitted.
