Les Lanternes Rouges: The Race for Information About Cycling Related Female Sexual Dysfunction

Sarah N. Partin, MSPH, Kathleen A. Connell, MD, Steven Schrader, PhD, and Marsha K. Guess, MD.
Published in Journal of Sexual Medicine. 2014 August; 11(8): 2039-2047.

Outline for April 2016 Pelvic PT Distance Journal Club
Sallie Rediske, PT, WCS

 

I.             Popularity of cycling ñ; largely driven by women.

A.            Nearly half cyclists are women.

1.            29-48 year-old females are driving the bicycle market.

II.            Purpose of literature review.

A.            Provide overview of current research regarding pelvic floor (PF) injuries and female sexual dysfunction (FSD) in women cyclists.

B.            Searchers used definition of FSD as defined by Sexual Function Health Council of American Foundation of Urologic Disease, 1998.

1.            English / English-translation only, 1998 and on utilized.

2.            PubMed, Medline, Google Scholar, Academic Search Complete, EBSCO databases, MasterFile.

3.            Search words: Cycling, female pelvic floor, female sexual dysfunction, pudendal nerve, cycling nerves, cycling blood supply, saddle pressures and cycling related neuropathies.

III.           In general population: central and peripheral neuro responses and vascular changes affect sexual response.

A.            Altered vaginal engorgement.

B.            Dyspareunia.

C.            Lack of lubrication.

D.            Altered sensation, including anorgasmia.

IV.          In cyclists evidence shows multiple causes of damage.

A.            Chronic compression at Alcock’s canal.

B.            Stretching of pudendal n. during pedaling between sacrospinous and sacrotuberous ligaments.

C.            Chronic compression in perineum and symphysis region.

V.            Evidence shows clear difference in way anatomy and physiology of women and men are affected by cycling.

A.            Wider pelvis.

B.            Lower center of gravity.

C.            Increased anterior pelvic tilt.

D.            Different saddle pressure distribution.

VI.          Table for summary of referenced articles. (Did not include three they did due to men subjects only.)

VII.         Take home from this literature review.

A.            Average number of subjects in the referenced studies = 24.9.

B.            Mode = 6, 20, 22.

C.            Cross-sectional analysis = 14; Case series = 3.

D.            Only one article actually examined FSD rather symptoms that are often associated with FSD. (Munarriz, 2002, but all subjects had FSD which prevented examiners from identifying role of ògenital sensation with FSD.)

1.            Evidence appears to support wider saddle for òpudendal n. compression in female cyclists. (Level B evidence.)

2.            Small study suggests gel-saddles òpain, pressure, and neural compression.

3.            Despite summary of authors, jury appears mixed on role of partial cut-out saddles for women cyclists. (Bressel & Larson, 2003 vs. Frobose et al., 2003, Guess et al, 2011) (“Comfort” as dependent variable vs. “pressure”.)

4.            Lower handlebars result in > perineal pressure and symptoms. (Level B evidence.)

5.            Female pelvises move more in the saddle than do male pelvises.

6.            NO studies have identified a correlation between saddle design or genital pressure and FSD.

VIII.        Critical analysis of article.

A.            Poorly edited with respect to references.

1.            References in bibliography are off by one when compared to text.

2.            Table includes reference (Keytel 2002) that is indicated as both 35 and 36 in the text.

3.            There is no reference 47 in the bibliography despite using this in both the text and table.

4.            In Table 1, Potter’s article is identified as 2007, but 2008 in bibliography.

5.            Most commonly referenced end note, 33, is incorrect and appears to not be mentioned in entire article based on numbering of bibliography (33 in bibliography is actually an article from 1995 which given the author’s use of the incorrect reference, gives this 20-year old article credit for the most progressive examination of saddle design and pressure to date.).

B.            Poorly edited with respect to assessment of partial cut-out saddles.

1.            All of the studies are small and are cross-sectional that study this and yet authors offer fairly concrete comment about the lack of benefit of partial cut-out seats.

C.            Poor editing can lead to inaccurate use of referenced material to complete other research and guide clinical behavior.

C.            Elucidates need for more research.

1.            Female and Male cycling studies.

a.            Standardized definitions.

b.           Methods of measuring.

c.           Better control of variables.

2.            Recreational vs. Competitive cyclists.

3.            Various types of cycles (road, mountain, cyclo-cross, fat tire).

                D. Complexity of assessing FSD.

                                1.            The FSD definition used is a “genital-focused” definition.

2.            Assumption that women experience sexual arousal same as males.