Is cycling bad for a woman's sexual or bladder health?
In 3,118 women, cyclists reported no more sexual dysfunction (FSFI) or urinary symptoms than swimmers and runners, but far more numbness and saddle sores (39% each). Survey.
Main caveat: Cross-sectional: associations, not causes; set-up and symptoms reported at one time, so riders may have changed saddle, bar or shorts because of symptoms (the…
This is the women's arm of the survey whose men's results are REF-1268, from the same UCSF-led group.
From April to December 2016, cyclists were recruited through Facebook advertisements and sports-club mailing lists in the United States, Canada, the United Kingdom, Australia and New Zealand, with swimmers and runners as the comparison group; the advertisements used images and keywords about the sports and avoided the study's outcomes "to reduce the potential for selection bias".
Women answered the Female Sexual Function Index (FSFI; dysfunction = total score under 27), the American Urological Association Symptom Index (AUA-SI; lower urinary tract symptoms = score over 7) and non-validated questions on urinary tract infections (UTIs), genital numbness and saddle sores, plus questions on their bike, saddle, padded shorts, time standing, saddle angle, handlebar height and riding surface.
Of 5,853 women who took part, 3,118 (53.3%) completed the survey: 1,053 non-cyclists, 1,656 low-intensity and 409 high-intensity cyclists.
Unadjusted, cyclists had higher FSFI totals than non-cyclists; after adjustment, high-intensity cyclists had lower odds of an FSFI total under 27 (aOR 0.7, 95% CI 0.6-0.95), while the adjusted FSFI totals and all six domain scores did not differ. Urinary symptoms did not differ.
Both cycling groups had higher adjusted odds of genital numbness (aOR 6.5 and 9.1), saddle sores (6.3 and 22.7) and a previous UTI (1.4 each); 39% of the 2,065 cyclists reported numbness, mostly in the labia or vagina and mostly lasting under an hour, and 39% saddle sores, with a dose-response pattern for saddle sores across lifetime miles.
In an exploratory model of bike and riding characteristics, no handlebar or saddle item reached significance for numbness or sores; women who rarely or never wore padded shorts had lower odds of both, off-road riding went with higher odds of sores, and a dual-pad saddle with higher odds of a UTI.
The authors name survivorship bias, unvalidated exposure cut-offs, unconfirmed UTIs, no distress measure and many tested hypotheses as limits.
Our reading: no worse sexual or urinary function in cyclists in this self-selected group, which cannot rule out problems in women who stopped riding; a clear signal that numbness and saddle sores are common among women who ride and more common with more riding; and no support from this survey's own data for any particular handlebar or saddle choice.
Set-up advice rests on the small laboratory pressure studies of 48 competitive women (REF-1272, REF-1273), which measure a marker, not these symptoms.
Protocol
Design: multinational cross-sectional anonymous online survey, pre-tested for readability; approved by the UCSF institutional review board. Five randomly selected participants received a $100 gift card.
Recruitment (April to December 2016): Facebook advertisements targeted at adults in the United States, Canada, the United Kingdom, Australia and New Zealand using cycling, swimming and running keywords and images (not the outcomes), and requests to the leaders of cycling, swimming and running clubs to circulate the survey to their mailing lists.
Sample: 5,853 women took part; n = 3118 (53.3%) completed the survey: 1,053 (34%) non-cyclists (swam and/or ran but did not regularly cycle), 1,656 (53%) low-intensity and 409 (13%) high-intensity cyclists. High intensity = cycling for more than 2 years, more than 3 times a week and a daily average of more than 25 miles; all other cyclists low intensity; cyclists were also grouped by quintile of lifetime miles. The cut-offs are not validated (the authors' limitation).
Who (Table 1): 65% under 40 years; 84% white; mean BMI 23.2 (SD 3.8); 81% sexually active (cyclists 84% and 86% vs non-cyclists 74%); cyclists were older and more often married than non-cyclists.
Outcomes: FSFI (sexual dysfunction = total score under 27; distress not measured, so the authors call it a measure of risk for female sexual dysfunction); AUA-SI (LUTS = score over 7; filling and voiding sub-scores); non-validated self-report questions on history of UTI, genital numbness (ever, location, average severity 1-10, duration) and saddle sores ("any skin symptom/irritation caused by, or exacerbated by, a bicycle seat").
Riding characteristics (exploratory): bike type, saddle type (seven categories, including noseless and dual pad), padded-shorts use, percent of time standing (0% to more than 20%), saddle angle, handlebar height (lower than vs higher than or even with the saddle) and riding surface.
Analysis: Stata 14; linear regression for continuous and logistic regression for binary outcomes; confounders chosen a priori.The sexual-function, numbness, saddle-sore and UTI models were adjusted for age, BMI, hypertension, diabetes, ischaemic heart disease, tobacco use, urinary symptoms, race, marital status and sexual activity; the urinary models for age, BMI, diabetes, tobacco use, history of UTI, race and marital status; the exploratory model for lifetime cycling miles and the same covariates without sexual activity.Two-sided tests; "a P value of .05 was considered statistically significant" (as printed).
Funding and interests (as printed): "Funding: Bicycle Reac Grant, Alafi Foundation (Dr Breyer)." "Conflict of Interest: The authors report no conflicts of interest." Affiliations: UCSF Urology and Epidemiology and Biostatistics; King Abdulaziz University; Washington University, St Louis; Urologic Oncology Branch, National Cancer Institute; Stanford University; Dell Medical School, University of Texas.No saddle or bicycle company appears among the authors or funders; the paper does not say what the "Bicycle Reac" grant is.
Key Results
| Outcome vs non-cyclists (Table 4, adjusted) | Low-intensity cyclists (1,656) | High-intensity cyclists (409) |
|---|---|---|
| Sexual dysfunction (FSFI total under 27), aOR (95% CI) | 0.9 (0.8-1.2), p = .74 | 0.7 (0.6-0.95), p = .02 |
| FSFI total, adjusted mean (non-cyclists 22.0) | 22.1, p = .55 | 22.3, p = .24 |
| LUTS (AUA-SI over 7), aOR | 1.0 (0.8-1.2), p = .50 | 1.0 (0.8-1.3), p = .84 |
| Previous UTI, aOR | 1.4 (1.2-1.6), p < .001 | 1.4 (1.1-1.8), p = .009 |
| Genital (perineal) numbness, aOR | 6.5 (5.1-8.2), p < .001 | 9.1 (6.8-12.4), p < .001 |
| Saddle sores, aOR | 6.3 (4.9-8.2), p < .001 | 22.7 (16.4-31.4), p < .001 |
Unadjusted (Table 3): FSFI total 20.8 (non-cyclists) vs 22.6 and 23.1; sexual dysfunction OR 0.8 (0.6-0.9) and 0.6 (0.5-0.8); numbness 5.7 and 7.0; saddle sores 5.8 and 19.5; UTI 1.6 and 1.8. The adjusted numbness and sore odds ratios are higher than the unadjusted ones.
Prevalence among the 2,065 cyclists (Table 2): numbness 814 (39%), located in the labia or vagina in 661 (81%), median severity 3 of 10 (IQR 2-5), lasting 1-59 min in 578 (71%) and more than 24 h in 16 (2%); saddle sores 797 (39%), in the labia or vagina in 424 (53%). Across all participants, 57.0% met the FSFI criterion and 51.4% reported a past UTI.
Lifetime miles: no relationship with sexual or urinary function; a clear dose-response relationship with saddle sores and a slight one with UTIs (Figure 1; values only in the figure).
| Exploratory model (Table 5), aOR (95% CI) | Genital numbness | Saddle sores | Previous UTI |
|---|---|---|---|
| Handlebar higher than or even with the saddle (vs lower) | 0.8 (0.7-1.0), p = .10 | 0.8 (0.7-1.0), p = .08 | 1.2 (1.0-1.4), p = .11 |
| Noseless saddle (vs wide, unpadded) | 3.1 (0.9-10.8), p = .07 | 1.8 (0.5-6.4), p = .35 | 1.2 (0.4-3.7), p = .81 |
| Dual-pad saddle (vs wide, unpadded) | 2.2 (0.7-6.9), p = .20 | 1.7 (0.5-5.5), p = .40 | 5.6 (1.2-26.2), p = .03 |
| Padded shorts rarely (vs always) | 0.6 (0.4-0.9), p = .03 | 0.4 (0.3-0.8), p = .003 | 1.2 (0.7-1.8), p = .53 |
| Padded shorts never (vs always) | 0.5 (0.4-0.8), p < .001 | 0.5 (0.3-0.7), p < .001 | 1.0 (0.7-1.4), p = .93 |
| Standing 10% of the time (vs 0%) | 0.7 (0.5-0.9), p = .02 | 1.3 (0.9-1.8), p = .20 | 0.8 (0.6-1.0), p = .09 |
| Standing more than 20% (vs 0%) | 0.5 (0.3-1.0), p = .07 | 1.1 (0.6-2.2), p = .69 | 0.5 (0.3-0.96), p = .04 |
| Off-road (vs urban streets) | 1.0 (0.6-1.6), p = .95 | 1.9 (1.1-3.2), p = .02 | 1.0 (0.6-1.5), p = .85 |
No saddle type was significantly associated with numbness or saddle sores; no bike or road characteristic was significantly associated with sexual dysfunction or LUTS (data not shown). Saddle angle level (vs nose down): numbness 0.7 (0.5-1.0), p = .05, saddle sores 0.8 (0.6-1.1), p = .18, UTI 0.9 (0.6-1.2), p = .35 — borderline for numbness at the paper's own .05 line and not discussed by the authors.
Numbers that do not add up:
The abstract labels the numbness and saddle-sore estimates "odds ratio [OR]"; Table 4 gives them as adjusted odds ratios.
The Conclusions say high-intensity cyclists "had better sexual function than non-cyclists", but after adjustment their FSFI total (22.3 vs 22.0, p = .24) and every domain score did not differ; only the dichotomised criterion (aOR 0.7) did.
The Discussion says standing "was associated with lower odds of self-reported genital numbness" and, with a higher bar, with "non-significantly reduced odds of reporting saddle sores"; in Table 5 only standing 10% of the time reached significance for numbness, and every standing category had a saddle-sore odds ratio of 0.9 or above (1.1 at more than 20%).
Table 3's UTI odds ratio for high-intensity cyclists, 1.8 (1.5-1.9), sits almost at the top of its interval; the Table 1 total mean BMI (23.2) is below all but one group mean and below their weighted average (about 23.9, our arithmetic); Table 1 prints "71 (1)" for partnered high-intensity cyclists (71 of 409 is 17%).
Mechanisms
Measured: sexual-function scores and urinary symptoms no worse in cyclists after adjustment; numbness, saddle sores and past UTIs reported more often, numbness and sores more with intensity and sores with lifetime miles; in the exploratory model, rare or no use of padded shorts went with lower odds of numbness and sores, off-road riding with more sores, and no handlebar or saddle item with either.
Authors' interpretation: they write that "cycling did not negatively impact sexual or urinary function" (causal wording for a cross-sectional design) and suggest the cardiovascular benefits of cycling may support sexual health; they attribute saddle sores and labial swelling to vascular and lymphatic compromise from chronic saddle pressure, off-road sores to more extreme changes in seat pressure, and the dual-pad finding to contact area and poor breathability — while saying the dual-pad and UTI associations may be spurious given the number of hypotheses, and that riders with sores or infections may have switched saddles because of them.They suggest a higher bar and standing "may be recommended for recreational cyclists", on non-significant associations.
Inference: the padded-shorts result runs against common advice and is cross-sectional: women who already had numbness or sores may have taken to padded shorts (reverse causation), and occasional or short-distance riders may be the ones who skip them; the model adjusted for lifetime miles, not for ride length. It is not evidence that padded shorts cause numbness or sores.
Inference: the adjustment set includes urinary symptoms and sexual activity, which may lie on the path between cycling and the outcomes (the authors say whether LUTS "is a true confounder or mediator" is unknown), so the adjusted estimates are not a clean "effect of cycling".
Inference: the laboratory pressure studies link a bar below the saddle and a cut-out saddle to higher perineal pressure in competitive women (REF-1272, REF-1273); this survey's self-reported, two-category handlebar item and seven saddle categories showed no significant association with the symptoms, so the two lines of evidence do not yet meet.
Practical Application
Is cycling bad for a woman's sexual or bladder health? In 3,118 women, cyclists reported no more sexual dysfunction (FSFI) or urinary symptoms than swimmers and runners, but far more numbness and saddle sores (39% each). Survey.
Numbness and saddle sores are common in women who ride (B+, cross-sectional): adjusted odds of numbness 6.5 (low intensity) and 9.1 (high intensity) times, and of saddle sores 6.3 and 22.7 times, those of swimmers and runners; most numbness was brief (13% under a minute and 71% 1-59 min). Asking about them is worthwhile; the survey does not show what prevents them.
What this survey found on set-up: neither a bar higher than or level with the saddle (aOR 0.8, p = .10) nor any saddle type was significantly associated with numbness or sores, and women who rarely or never wore padded shorts had lower, not higher, odds of both (exploratory, cross-sectional; the symptom may have come first). Do not quote this survey as support for a higher bar, a particular saddle or padded shorts.
Lab pressure evidence, from other entries: in 48 competitive women, a bar below the saddle and a cut-out saddle went with higher perineal pressure and a wider saddle with lower peak pressure (REF-1272, REF-1273; B-, a pressure marker, not symptoms). Not from this paper; the base's own practice: a bar level with the saddle or a saddle wide enough for the sit bones is a reasonable change to try for persistent numbness, one change at a time.
See a clinician. Not from this paper; the base's own practice: numbness that lasts after rides or keeps returning, a sore that spreads, is hot or comes with fever, a persistent labial swelling or lump, pain with sex that lasts days, or repeated urinary infections go to a clinician (gynaecology, urology or sports medicine); the assistant does not diagnose.
Limitations
Cross-sectional: associations, not causes; set-up and symptoms reported at one time, so riders may have changed saddle, bar or shorts because of symptoms (the authors make this point for saddles).
Selection: recruited through Facebook advertisements and sports clubs — a self-selected sample, 53.3% of the women who started completed it; survivorship bias, as women with sexual problems from cycling may have stopped riding before the survey (the authors' limitation); swimmers and runners are active women, not a general-population comparison.
Measures: FSFI under 27 without the distress criterion (a measure of risk, the authors say); UTIs self-reported and not confirmed by culture or treatment; numbness and saddle-sore questions not validated; intensity cut-offs not validated; frequency of sexual activity not controlled; the effect of single long rides not measured (only 12 women rode more than 350 miles a week).
Adjustment: the numbness and saddle-sore odds ratios are adjusted (Table 4) and higher than the unadjusted ones (Table 3); the adjustment set includes urinary symptoms and sexual activity, which may sit on the causal path.
Set-up data are coarse and exploratory: self-reported categories tested in one model with many comparisons; the authors say some associations may be spurious.
Reporting: the abstract labels the adjusted numbness and saddle-sore estimates "OR" rather than "aOR"; the Conclusions state better sexual function that the adjusted scores do not show (only the dichotomised criterion, aOR 0.7, differed); the Discussion states set-up benefits that Table 5 does not show (Key Results).
Funding and conflicts: "Funding: Bicycle Reac Grant, Alafi Foundation (Dr Breyer)"; "The authors report no conflicts of interest" (full text).
How this entry was checked and changed
Why this level
the rubric's B+ row for a cross-sectional study with 100 or more (n = 3118), with validated instruments for sexual function (FSFI) and urinary symptoms (AUA-SI) and confidence intervals for every odds ratio. The prevalence figures carry that level; the odds ratios are correlational (the rubric B row, as for the cross-sectional fit survey REF-1263). Held there, not higher, because it shows associations only, the sample selected itself through social media and clubs, numbness, saddle sores and infections come from non-validated self-report questions, the cycling-intensity cut-offs are not validated, and sexual dysfunction was scored as an FSFI total under 27 without the distress criterion (the authors' limitations). Read from the full text: the eScholarship copy of the publisher PDF that OpenAlex lists for this DOI (15 pages, retrieved 2026-10-27)
Full text (checked 2026-10-27)
In total, 5,853 women participated in the study and 3,118 (53.3%) completed the survey: 1,053 (34%) non-cyclists, 1,656 (53%) low-intensity and 409 (13%) high-intensity cyclists (full text)
High-intensity cyclists were defined as respondents who cycled for more than 2 years, more than 3 times/wk, and a daily average of more than 25 miles (full text)
Sexual dysfunction was defined as a total FSFI score less than 27; 1,776 (57.0%) met criteria for sexual dysfunction (full text)
Among 2065 cyclists: genital numbness 814 (39%), in the labia/vagina 661 (81%), lasting 1-59 min in 578 (71%); saddle sores 797 (39%) (full text)
Table 4, adjusted: sexual dysfunction aOR 0.9 (0.8-1.2), .74, and 0.7 (0.6-0.95), .02; FSFI total 22.0, 22.1 and 22.3 (full text)
Table 4, adjusted: perineal numbness aOR 6.5 (5.1-8.2) and 9.1 (6.8-12.4); saddle sores aOR 6.3 (4.9-8.2) and 22.7 (16.4-31.4); UTI 1.4 (1.2-1.6) and 1.4 (1.1-1.8) (full text)
Table 5: handlebar higher or even with saddle, numbness 0.8 (0.7-1.0), .10, saddle sores 0.8 (0.7-1.0), .08; noseless saddle, numbness 3.1 (0.9-10.8), .07 (full text)
Table 5: padded shorts never, numbness 0.5 (0.4-0.8), saddle sores 0.5 (0.3-0.7); rarely, 0.6 (0.4-0.9) and 0.4 (0.3-0.8) (full text)
Table 5: standing more than 20%, numbness 0.5 (0.3-1.0), .07, saddle sores 1.1 (0.6-2.2), .69 (full text)
Survivorship bias: "those who experienced sexual dysfunction due to cycling may have quit before entering into our study" (full text)
Conflict of Interest: The authors report no conflicts of interest. Funding: Bicycle Reac Grant, Alafi Foundation (Dr Breyer) (full text)