Preventing Peloton Perineum

Ask Dr. jen

Potential future topic idea (or maybe a just me thing): saddle sores from cycling. I'm loving the Peloton and started doing longer rides consistently recently, but man, it has been hard on the soft tissue down there. I've read all the suggestions from cycling sites (chamois cream, padded shorts, seat adjustments, etc.) but I'm curious from a physician's perspective what the best course of action is once things are already sore. I hate to stop doing exercise I really enjoy when I need it the most because it hurts to sit.

• Via The Vajenda

Short Take

Spending time on a bike saddle can have ramifications, but there are many tips and tricks for limiting the wear and tear on your perineum.

Tell Me More

There are several things that can make you saddle sore

• Pressure - This can lead to general soreness and irritation.

• Chaffing - Redness, irritation, and even breakdown due to friction. Hanging around in wet clothes after a ride can also contribute because the wet fabric creates additional friction.

• Pressure on blood vessels and nerves - This can cause temporary numbness and over time, it could be a risk factor for chronic pain. This is something that is typically only a potential concern when someone is spending a lot of time in the saddle.

As we age, our tissues may become more vulnerable to the effects of pressure and may chafe more easily and take longer to heal. If you are in menopause and not using vaginal estrogen, the inner aspect of the labia minora (inner lips) and vaginal opening may become more sensitive to pressure.

It’s About You AND the Bike

Lance Armstrong's infamous autobiography was called, “It’s Not About the Bike.” And yes, in his case, it was about the drugs, but for you, it is about you, and it’s about the bike, and where the twain meet.

There are several general measures to consider, and these are important whether you are having issues or not (meaning it’s a good idea to be mindful of these to maintain perineum perfection).

• Wear padded bike shorts. Really, this can make a huge difference. And they can be super cute (who doesn’t deserve a bike kit?). I personally love Cycology clothes. You can shop here (I’m not an affiliate, but I like to share what I like)—also, no underwear with bike shorts, just the glory of your vulva against the padding.

• Moisturize your perineum. Hydrated tissue is more resilient. Apply daily to the labia majora, perineum, and perianal area. I do this when I get out of the shower, and this makes a big difference for me. I personally love Cerave Moisturizing Cream for Face and Body and CeraVe Healing Ointment, and I apply one or the other daily. Vaseline, coconut oil, and Aquaphor are other options. There are a plethora of vulvar moisturizers on the market, and none have been tested in any meaningful way, so a lot of this comes down to trial and error about what works for you and of course, some key ingredients to avoid. If you are not using vaginal estrogen and the discomfort is right at the vaginal opening and/or inner labia, you could be irritating tissues affected by genitourinary syndrome of menopause (GSM), so getting started on vaginal estrogen may also help.

• Check to make sure your seat is the right height and that it is parallel to the floor or even tilted slightly nose down. If it is nose up, it will increase pressure. I’m no bike mechanic, but Dr. Jen Adjacent knows a lot about bikes. He says the seat on the Peloton could be angled slightly if you need it (there is a bolt to loosen with the wrench that came with your Peloton. You will see it below the saddle and when you loosen it, it allows you to tilt the saddle up and down and forward and backward).

• Take stock of how your posterior is positioned on the Peloton. Make sure your bike saddle is wide enough so you are sitting on your ischial tuberosities (sit bones). If the seat is too narrow, you will put more pressure on your vulva, which can quickly become uncomfortable. Some people will need a wider saddle. Even if the saddle is a good fit width-wise, there is a seemingly infinite universe of bike saddles that you might find more comfortable, and I think many (likely most) can be fit on the Peloton. In addition to wider saddles, they make them with more cushion as well as saddles with a cut-out in the center to reduce pressure on the vulva (and probably on the testicles, but I have no professional interest there). I find the Peloton saddle okay, but I don’t do long rides. I have a wider, nicely padded saddle for my road bike. If the Peloton seat is uncomfortable, consider going to a bike store and trying some different saddles. They even make noseless seats, which take the pressure off the vulva altogether. I discuss these when people have chronic pain in the vulva (a condition called vulvodynia).

My Perineum Still Hurts, Now What?

Any persistent pain or discomfort despite several of the above measures warrants a trip to your doctor, preferably a gynecologist. Two conditions that can lead to excessive pain from things that shouldn’t cause pain are vulvodynia and skin conditions, like lichen sclerosus.

If you find that you are numb in the saddle, take a good look at seat height, see about angling the nose of the saddle down, and make sure you are wearing padded shorts. Numbness can result from pressure on blood vessels, which reduces blood flow to nerves and tissues, and it can also be due to nerve compression. If any numbness persists, see your doctor. If you have diabetes, tell your doctor immediately about any numbness, and you also need to be extra careful about preventing any skin breakdown from chaffing.

What About Chamois Cream?

This goes between your skin and your bike shorts (so yes, it gets all over the padding) to reduce friction. If chaffing is your issue, this is what you need, but it’s uncommon to need chamois cream for shorter rides, although you can certainly try it out.

The “active” ingredients (the thing that protects your skin) in chamois cream are emollients, occlusives, and humectants, and that could be mineral oil, petrolatum, shea butter, aloe, glycerin, or lanolin. Be wary of European-style creams as they may have methanol or witch hazel to produce a cooling effect or products with essential oils, like lavender and tea tree oil. They don’t add anything medicinal, just a nice smell and the risk of irritation. Menthol and essential oils can be especially irritating to the vulva and some people are allergic to lanolin. Looking at the ingredients of several chamois creams, they don’t seem to have anything “better” than my one true vulvar love, Cerave Healing Ointment, but this is clearly an area open to experimentation. If something works for you and isn’t irritating, great.

Recovery

If I do a longer ride, I like to apply an ointment after I’ve showered. Again, I like Cerave Healing Ointment, but regular old Vaseline is a great option. My general rule is the more “sore” you are, the heavier (or thicker or more ointment-like) your product should be (this is based on nothing but clinical experience, but I have a lot of that). If people are interested, I can write a follow-up post about the key ingredients in vulvar moisturizers and why I recommend the products that I do. I could probably do a head-to-head series because I had a little bought of perianal dermatitis a few weeks ago and thought it was a grand opportunity to try all the products in my personal stash. There were some clear winners and losers that made me go, “Ouch.”

I hope all that helps.

And Happy Cycling! I’m Vajenda on The Peloton!

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