REF-1273 · Guess et al., 2011 · The Journal of Sexual Medicine · Paper · PubMed · Free full text

Does a cut-out saddle take pressure off the perineum?

Not here: in 41 competitive women, cut-outs went with 4.41 kPa higher mean and 11.54 kPa higher peak perineal pressure; wider saddles did better.

Main caveat: Cross-sectional, one 40-60 s trainer bout with cadence and power not controlled.
limited, mixed evidenceMeasured on trained to highly trained athletes

Guess and colleagues (Yale, Texas A&M, NIOSH, Albert Einstein College of Medicine) analysed the 48 premenopausal competitive women cyclists they had enrolled in 2003 for a comparison with runners — the same 48 women whose handlebar height is analysed in REF-1272.

Each rider brought the bike and saddle she usually rode; saddles were classed as traditional (solid, tapering to a nose) or cut-out (nosed, with part of the centre removed), and saddle width was derived from a photograph and the measured length.

On a Minoura MagTurbo trainer at moderate resistance and a comfortable cadence, a 256-sensor Novel Pliance map recorded saddle pressure for 40-60 s; the perineal region was a 7.5-cm-wide strip projected forward from the two sit-bone pressure peaks. Genital sensation was measured as vibratory thresholds with a Medoc Vibratory Sensory Analyzer 3000 at eight sites.

Of the 42 riders with pressure data, 23 (54.76%) used traditional and 19 (45.24%) cut-out saddles. In the final models, a traditional saddle went with a mean perineal pressure 4.41 kPa lower (95% CI −7.57 to −1.25) and a peak perineal pressure 11.54 kPa lower (−20.22 to −2.86) than a cut-out, and a wider saddle with lower peak perineal and mean total pressure.

On 15 of the 19 cut-outs the highest pressures lay in the perineal region along the edges of the hole. Higher perineal pressure went, if anything, with lower (better) vibratory thresholds on bivariate analysis, and that association disappeared after adjustment for age; saddle type did not affect sensation.

The authors conclude that cut-out and narrower saddles negatively affect saddle pressures in women, that no effect on pudendal nerve function was apparent, and that longitudinal studies are needed — and they add that differences of 4 and 11 kPa may not have practical significance.

Our reading: the best data the base holds against the common assumption that a cut-out relieves the perineum in women, but it is one short pressure snapshot on the riders' own saddles, with no symptom outcome.

Protocol

Design: cross-sectional secondary analysis of 48 cyclists enrolled in 2003 alongside 22 runners (Guess et al. 2006); IRB-approved; written informed consent; telephone prescreening. The same 48 women are analysed for handlebar height in REF-1272.
Eligibility: premenopausal, English-speaking women riding on average at least 10 miles a week, 4 weeks a month; excluded: central or peripheral neurological deficits or diseases that can cause neuropathy (prior stroke, diabetes mellitus, HIV/AIDS), hypertension needing medication, active vulvar lesions. The recruitment route is described in the 2006 paper, not here.
Riders (Table 1): n = 48; age 35.98 ± 6.90 years; BMI 22.55 ± 3.15; 8.31 ± 5.97 hours and 99.24 ± 74.11 miles a week; 8.02 ± 6.78 years riding.
Saddles: traditional 23 (54.76%), cut-out 19 (45.24%); width 5.81 ± 0.57 (no unit given; the companion paper labels the same variable in inches, REF-1272); 6 riders without pressure data, baseline characteristics not different with or without them.
Pressure: Novel Pliance map, 16 × 16 sensors of 1.25 cm, calibrated to 300 kPa; own bike on the trainer, saddle and bar in the usual position, moderate resistance, comfortable cadence (cadence, resistance and power not controlled); 40-60 s at 20 Hz, low-pass filtered at 5 Hz; mean and peak total pressure over the whole saddle; mean and peak perineal pressure over the region of interest.
Sensation: ascending vibratory thresholds (microns) at the clitoris, right and left perineum, distal anterior and posterior vagina, right and left labia majora and urethral meatus, in the lithotomy position, the rider blinded to the stimulus; six repeats per site.
Analysis: bivariate linear regression; multivariable models by forward stepwise selection keeping p < 0.05; candidate predictors age, BMI, saddle type and width (hours and miles a week only in the sensation models); observations beyond 3 SD treated as outliers and the "outliers out" results presented (two riders for pressure, two for right vulvar thresholds); transformed and weighted models checked and reported as equivalent; Stata 11.
Funding and interests: NIH grants 3P01DK60037-03S1 and 5K12HD047018, the Robert Wood Johnson Foundation Harold Amos Faculty Development Program and the Bronx Center to Reduce and Eliminate Ethnic and Racial Health Disparities (full text). "Conflict of Interest: None." Four authors were at the National Institute for Occupational Safety and Health; the paper states that mention of products does not imply endorsement. No saddle maker is among the authors or funders.

Key Results

Saddle pressure, all riders with dataMean ± SD (kPa)
Mean perineal18.90 ± 6.58
Peak perineal57.48 ± 19.83
Mean total15.18 ± 3.43
Peak total66.05 ± 21.55
Final multivariable model (outliers out; n = 41)PredictorCoefficient (95% CI)p
Mean perineal pressure (R² 0.3335)Traditional (vs cut-out) saddle−4.41 (−7.57, −1.25)0.008
Age, per year−0.34 (−0.57, −0.11)0.005
Peak perineal pressure (R² 0.2636)Traditional (vs cut-out) saddle−11.54 (−20.22, −2.86)0.010
Saddle width−12.36 (−19.04, −4.77)0.002
Mean total pressure (R² 0.6654)BMI0.56 (0.27, 0.86)< 0.000
Saddle width−2.41 (−3.62, −1.19)< 0.000
Peak total pressurenone retained——
Pressure maps (Fig. 2): on cut-outs, the highest pressures were along the edges of the cut-out in 15 riders ("80%") and over the sit bones in 4; on traditional saddles, over the sit bones in 5, spread over the rear of the saddle and the sit bones in 11, and isolated to the perineum in 4; the single widest saddle spread low pressure over its whole surface.
Bivariate: a traditional saddle went with lower mean perineal pressure (−4.98, p = 0.006) but not significantly lower peak perineal pressure (p = 0.148); saddle width went with lower peak perineal, mean total and peak total pressure but not mean perineal pressure.
Sensation: on bivariate analysis higher mean perineal pressure went with lower thresholds (better sensation) at the anterior vagina (−0.151, p = 0.017) and urethra (−0.194, p = 0.026), not significant after adjustment for age; age went with higher thresholds (anterior vagina 0.151 per year, p = 0.001). Saddle type was not associated with sensation.
Numbers that do not add up: every coefficient in Tables 3-4 sits at the centre of its confidence interval except saddle width for peak perineal pressure, −12.36 with an interval of −19.04 to −4.77 (centre −11.9, our arithmetic); Table 4's F(3, 37) implies three predictors but lists two; the abstract calls the pressure-sensation link "an inverse correlation" without saying it ran opposite to the hypothesis (more pressure, better sensation).

Mechanisms

Measured: cut-outs concentrated pressure at the edges of the hole in most riders and went with higher perineal pressure; wider saddles went with lower peak perineal and total pressure; heavier riders had higher total pressure.
Authors' interpretation: pressure peaks along the edges of a cut-out, and averaging over the whole saddle can hide it; the pelvic-tilt explanation for cut-outs is made in the companion paper (REF-1272), not here; a wider saddle supports the pelvic bones and spares the perineum, as in men; lower perineal pressure in older riders may mean women with pressure problems stop riding, leaving a selected group.
Inference: pressure on a saddle is physical, but the riders chose their saddles, and riders with symptoms may have chosen cut-outs and also differ in position and bar height (REF-1272 found bar height mattered in the same women).
Inference: no link between pressure and sensation here could mean no acute effect at these pressures, a ride too short to change thresholds (the authors' point), or a test too insensitive; one snapshot cannot show cumulative injury.

Practical Application

Does a cut-out saddle take pressure off the perineum? Not here: in 41 competitive women, cut-outs went with 4.41 kPa higher mean and 11.54 kPa higher peak perineal pressure; wider saddles did better.
Do not assume a hole relieves the vulva and perineum (B-, cross-sectional, pressure only): the highest pressures sat along the edges of the cut-out in 15 of 19 riders. If a cut-out feels better to a rider, that is her answer; the measurement did not favour it.
Width mattered too: a wider saddle went with lower peak perineal and mean total pressure, but not mean perineal pressure; the models do not rank width against a cut-out. Not from this paper; the base's own practice: choose a saddle wide enough to carry the sit bones and test it over real rides, one change at a time.
Scale of the effect: the authors themselves say 4 and 11 kPa differences may not have practical significance, compared with a fall from about 20 to 7 kPa on no-nose saddles in men (REF-1270); no-nose saddles were not studied in these women.
See a clinician. Not from this paper; the base's own practice: numbness that lasts after rides or keeps returning, persistent labial swelling, a spreading or hot sore, or pain with sex goes to a clinician; the assistant does not diagnose.

Limitations

Cross-sectional, one 40-60 s trainer bout with cadence and power not controlled; terrain, hand position and weight shifts during the pedal stroke not considered (the authors' limitations).
Same sample as [REF-1272]: the two papers are not independent evidence.
Own saddles: saddle type and width were the riders' choice, not assigned.
Small and selected: 48 riders, 41 in the models; competitive, premenopausal, mostly normal-weight; the authors note competitive riders may be at lower risk and older riders may be survivors.
Model building: forward stepwise selection and the exclusion of outliers (one with a probable recording error) shaped the final models; the authors report that the outliers drove some associations.
Markers, not symptoms: no numbness, pain or sexual-function outcome in this paper; vibratory thresholds did not differ by saddle.
Reporting: one off-centre confidence interval and one mismatched F statistic (Key Results).
Funding and interests: NIH (NIDDK, NICHD), the Robert Wood Johnson Foundation and Bronx CREED; no conflicts declared.
How this entry was checked and changed
Why this level

the rubric's B row for a cross-sectional study, lowered one step: the outcome that differed is a marker (saddle pressure in one 40-60 s trainer bout with cadence and power not controlled), the sensory measure showed no saddle effect, each rider used the saddle she had chosen, the models were built by forward stepwise selection with outliers removed, and n = 48 (41 in the models); the authors themselves say the pressure differences may lack practical significance. Read from the full text (PubMed Central author manuscript, the repository copy listed by OpenAlex; Europe PMC's full-text service returned no copy)

Full text (checked 2026-10-27)
In 2003, we enrolled 48 cyclists and 22 runners; 6 cyclists were missing saddle pressure values (full text)
Saddle type: traditional 23 (54.76%), cut-out 19 (45.24%); mean perineal pressure 18.90 ± 6.58 kPa, peak perineal 57.48 ± 19.83 kPa (full text)
Women riding cut-out saddles had, on average, a 4 and 11 kPa increase in mean and peak perineal saddle pressures (p= 0.008 and p= 0.010), after adjustment for other variables (full text)
Final models: traditional saddle −4.41 (−7.57, −1.25), 0.008, for mean perineal pressure; −11.54(−20.22, −2.86), 0.010, for peak perineal pressure; saddle width −12.36(−19.04, −4.77), 0.002 (full text)
Mean total pressure: saddle width −2.41(−3.62, −1.19), BMI 0.56(0.27, 0.86), R2 = 0.6654, N=41 (full text)
Cut-out saddle with pressure in the perineal region, along the edges of the cut-out, n=15; for 80% of the women using a cut-out saddle the highest pressures were in the perineal region (full text)
The authors: "the 4 and 11 unit kPa reductions seen in our riders may not have practical significance" (full text)
Supported in part by NIH grants 3P01DK60037–03S1 and #5K12HD047018; Conflict of Interest: None (full text)