A Severe Problem Few Cyclists Have

Over the past few years, we have been keeping track of a particular health issue experienced by roughly 1–2% of cyclists. It appears to be pretty severe for those affected, with the more troubling part being that for roughly half of these folks, they were not aware of the problem until it was too late. So read on, because you might very well be one of them.

What’s the problem?

When riding on the hoods and tops, most cyclists’ sitbones and hence weight are supported by the saddle wings:

This is the intended and natural way to use bike saddles.

For a small minority (1–2%), they ride instead on the saddle nose. That is, most of their weight is supported by the nose, with the majority of pressure on the perineum, and the rest on the inside of their rami:

You’re kidding. I tried riding on the saddle nose like that once and it was really uncomfortable. Who would do such a thing?

The vast majority of cyclists avoid riding this way for three reasons:

1. They develop numbness in their perineum during the course of a ride.
2. They experience significant, immediate pain in their perineum.
3. The back half of the saddle is wider and just looks like a more comfortable place to sit on.

For the small minority (1–2%), approximately half either do not or experience only minimal discomfort when sitting on the saddle nose. These cyclists also tend to mistake the inside of their rami for their sitbones.

The other half ride bikes with geometries that do not fit them, e.g. their bikes are too big and their saddles cannot be pushed far enough forward. Due to various reasons, they are unable or unwilling to make changes to components such as seat posts or bike frame.

Finally, some cyclists also incorrectly assume that since they had a bike fit done before, that must mean they are sitting on the right place on the saddle. In reality, we have found that a significant number of bike fitters are either unaware of the issue, and/or do not have the tools or methodology to detect and resolve such a problem.

But… but… it’s more ‘pro’ to ride like this. Right? Right?

A more aggressive posture first requires that the handlebars be significantly lower than the saddle. This is a necessary, but insufficient, condition. Forward rotation of the hips when getting from the tops onto the hoods or drops is also needed, like so:

Note that with hip rotation, it is the sitbones and rami that support body weight, not the inside of the rami and perineum. The former utilizes our skeletal structure and is preferable, the latter our soft tissues and is not.

My saddle has a cutout! That solves all perineum problems, right?

Unfortunately we know of cyclists who use saddles with cutouts but still encounter issues. It seems that using the inside of the rami to support weight is insufficient, we need the sitbones to do so.

All right, so what’s the consequence?

The cyclists we encountered who rode in such a manner typically develop health issues after a number of months. Specifically, as the perineum, or soft tissue region, is not intended to support our weight, the body reacts to the pressure by depositing fat in the region to harden it. Consequently, this constricts the blood vessels and nerves in the perineum. When the situation becomes sufficiently severe, surgery is required to mitigate the symptoms.

Wait, I’m a gal, this is a guy-only thing, right?

No, unfortunately we have encountered females with similar issues.

How do I check I’m sitting on the right place?

1. Make sure you know where your sitbones are, that your saddle is wide enough to provide support, and that you are sitting sufficiently far to the rear of your saddle for your sitbones to be supporting your weight. Some riders, especially guys, just assume that they have narrow sitbones: it helps to be honest with oneself.
2. Check your saddle: some saddle covers’ surface become shiny with prolonged body contact. Having the middle section, rather than the rear portion, be shinier than the rest of the saddle is an indication that you have been sitting too far forward on your saddle.

I think I’ve been riding on the nose, and may have the issue. What should I do?

We strongly recommend that you stop riding immediately, and consult with a medical doctor. At this time, we do not know if the absence of pressure on the perineum after a prolonged period of riding on it will let the body heal itself and undo the damage already done.

If/when the doctor says cycling can be continued, it will be necessary to change your bike and/or components. This is to allow for the correct adjustment and usage of your saddle, which in turn lets your sitbones and not your perineum support your weight.

But changing bike components is so troublesome!

It’s a question of whether you decide to make changes to your bike, or face the significant risk of having permanent damage done to your perineum resulting in the need for surgery and the possibility of you never getting back on your bike. We, and just about everyone we know, would choose the former.

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