With many people doing more indoor riding during this COVID19 lockdown situation, I thought it would be a good time to revisit the ‘Flipping Flapmash’ blogpost I wrote at the end of 2018 and share how, after years’ of ongoing suffering and two operations, I have finally managed to stay totally free of those pesky saddle sores for the last year and a half.
So what's the secret ?
I can’t claim to have found a ‘magic wand’ to avoid and cure all saddle sore issues, but here are a few things which, in combination, have helped me to be totally free of saddle sores for nearly 20 months now. Riding without pain is so much more fun ! Even if only half these tips can help others to enjoy their riding more, it is worth sharing.
Tip 1: no hair removal
Don’t remove pubic hair ! Every time my pride outweighed my common sense, I could be guaranteed to have an infected follicle or at the very least an inflamed bump that would cause discomfort. As per Dr Jane Sterling’s advice to the women’s GB cycling team, pubic hair has a protective function; it helps to move sweat (and bacteria) away from the skin and also provides some protection against friction. Simply trimming your pubic hair and keeping it at about 0.5-1 cm length (so it is not too stubbly either) can be a happy compromise between wanting to ‘look tidy’ and avoiding saddle sores.
Tip 2: no soap
Of course keep following government advice and wash your hands with soap, but avoid shower gels, shampoos and other skin care products that are packed with chemicals. The human skin represents the first line of defence against external chemical and microbial threats. Skin care products that are stuffed full of chemicals change the diversity and structure of molecules and bacteria on the skin. The problem is that, as well as germs, these chemicals get rid of the skin’s own protective oils and alters its pH level. Now, I mostly just shower with hot water and wash my hair once a week with a skin biome-friendly product. Dr Jane Sterling also advises against soap and instead recommends washing with Dermol 500, a mild antimicrobial emollient and moisturiser that is commonly used for the management of dry and/or itchy skin conditions.
Tip 3: lubricate
Again, on Dr Jane Sterling’s recommendation, I have started using Doublebase gel, a cheap over-the-counter moisturiser containing liquid paraffin, ahead of rides instead of chamois cream. Doublebase gel, when used regularly, helps to maintain and restore the skin’s natural moisture levels. You may wonder why not use chamois cream ? From a dermatological point of view, Doublebase, like other emollient products marketed for dermatitis of any cause, has a mild anti-inflammatory agent. I also like the texture of Doublebase gel (not so thick) and it is relatively cheap compared to most chamois creams, which is a good thing when like me you like to ride a lot or enjoy long rides and want to re-apply regularly. * Note for newer riders: you don’t apply it to the actual pad, but to your skin (sit bones, groin, outer labia/perineum as required)
Another important point made by Dr Jane Sterling during the Casquette panel talk at the London Bike Show in early 2019 is that protecting yourself from friction becomes even more important for peri- and post-menopausal women. As oestrogen levels start to drop and bottom out, the skin on of the vulva (the labia majora in particular) becomes dryer and less elastic. Pubic hair can also become softer and thus offer less protection.
Tip 4: saddle pressure mapping
It always baffles me how reluctant some cyclists can be when it comes to spending money on the single thing that is most likely to give them more comfort, and thus enjoyment, while riding. Please save yourself a lot of money and more importantly a lot of pain buying and testing the umpteenth saddle. Get yourself booked in for a saddle pressure mapping test. If you live in London, I can highly recommend Jimmy Wilson at Sigma Sport, but there are various other bike fitters with experience using Gebiomized pressure mapping too. It really is eye-opening to see exactly how different saddles fit you; how the pressure division changes at different points throughout the pedal stroke and in different positions; how hot spots can be eliminated; and how small adjustments can make not only a noticeable difference, but also a measurable difference. Here is a short video where Phil Burt, former Team Sky and British Cycling physio, demonstrates how gebioMized saddle pressure mapping works.
Tip 5: don't sacrifice comfort for speed
During all the years that I was struggling with my saddle sores I was riding two bikes: a Scott Contessa Foil and Specialized Shiv TT. Both are awesome bikes, but they are also among the stiffest, harshest frames you could possibly get ! If you lived somewhere with lovely smooth tarmac or did less miles, you would be more likely to get away unscathed. It wasn’t until I bought my J.Laverack J.ACK that I discovered the beauty of titanium, almost ‘floating’ over the rough and potholed UK roads. For many riders a titanium bike is the sort of thing reserved for 50th birthdays. But if you can afford it, don’t wait. Titanium bikes really are for life and your bum (and hands) will be thanking you.
Tip 6: only settle for a perfect chamois fit
When it comes to cycling shorts, don’t settle for anything but a perfect fit. I won’t be recommending any specific brands or types of shorts here as everyone has their own preferences and there are plenty of articles about ‘the 10 best bibshorts for women’ etc.
Shorts vs bibshorts comes down to personal preference and ease of toilet stops, but personally I prefer bibshorts as I feel the chamois stays better in place. The number one thing, obvious as that may seem, is fit. Don’t settle for anything less than the perfect fit as it will come back to bite you in the bum. The fit of the chamois pad should be really snug, yet you want the bibshort material to be 4-way stretch. The fit should be tight and move with you like one single piece, rather than that wiggling diaper feel some bibshorts can leave you with.
The next thing I would look for is a seamless chamois with as little texture as possible and none or only flat stitching, so there is nothing that can irritate your skin. The chamois should also be designed to wick well and dry very quickly; some brands even have added some perforations to the foam layer in the pad.
Don’t get lured into the idea that more padding is better. What matters most is the thickness of the padding once it has been compressed by your body weight when sitting on the saddle. Surplus bulk just creates heat, sweat, and possibly also friction. The less thickness you can get away with the better. Instead of greater thickness, look for higher density, especially for longer rides (as long as it doesn’t become too stiff!). Pads do wear out over time. So if your favourite pair of bibshorts is no longer as comfortable, it may well be that you have worn the padding out through compression over time.
There are many innovators when it comes to good chamois pads for women. However, one brand really stands out for me by offering chamois pads in different widths in all its designs. You can fine-tune your chamois pad based on the width of your sit bones and your saddle, irrespective of whether you need a size XS or XL for the bibshorts. Many brands develop their chamois pads through (pro) rider feedback, but this is the only brand that I know of that collaborated with gebioMized (see tip 4 above) for the design.
Until recently I wasn’t convinced about the need for indoor cycling shorts, but after 3 weeks of daily virtual races (another blog about that soon), I now totally understand the niche these fill. The mad Zwift distance record ride in 2017 had already taught me about the need to change bibshorts every few hours when doing longer indoor rides as everything just get much more wet and aggravated sooner. When you are a heavy sweater (ie me) and ride at or near threshold for 1 to 2 hours every day, the waterfall streaming down your legs and size of the puddle on the floor become really telling. Bibshorts made from a lightweight, breathable material (eg through small perforations in the pad and along the thigh) can really enhance airflow and improve the cooling effect. There may be other brands, but Le Col and dhb are examples of brands catering well for the (female) indoor cyclist – alternatively you can of course wear your oldest pair of bibshorts that has pretty much been left perforated anyway, but the chamois pad is likely to be worn out too…
Tip 7: iron out imbalances
This one was by far THE single biggest game changer for me. When you look at every single aspect of what may be causing your saddle sores and once you have made all the adjustments you can possibly think of, you may be left with the single biggest reason why you keep having issues: it may be you … You can test all the saddles and chamois creams in the world, but if you are wonky, you are likely to continue to have issues. Bike fitters will often pick up on wonkyness and correct for functional leg length differences with shorter cranks or shoe shimmies. However, if you continue to have saddle sores on one side only, then this is a strong indicator that you have significant muscular imbalances that need to be addressed off the bike first (through a targeted gym programme or Pilates exercises), before you will find comfort on the bike. In my case it was 8-12 weeks of specific Pilates exercises for glute imbalance that eventually straightened me out.
It is fascinating how even a simple exercise like a shoulder bridge can help awareness if you focus on where your weight is in space (e.g. think about the pressure in your feet and if it is even from left to right). Similarly, the humble glute bridge can be effective to address glute imbalance if, you work one glut at a time by holding the hips up and then switching one glute off and on again so the hip dips slightly on that side towards the mat.
Other useful exercises include clams, side lying leg lifts and fire hydrants for the weaker glute, bilateral movements with resistance bands around your knees/ankles/feet (such as backward/forward sumo walks and sideways crab walks) and (later on) low to medium-load symmetrical bilateral movements (such as squats, deadlifts and hip thrusts). You can also do single leg strength work (eg reverse lunges, single leg RDLs, Bulgarian split squats, etc) or core stability work (eg side planks or Pallof press), but don’t go too heavy and do twice the volume for the weaker side compared to the stronger side.
Tip 8: pay attention to your nutrition
When I suspected HS (see previous blog), I went on an elimination diet for a little while, cutting out anything that may cause inflammation such as refined sugar, dairy, yeast etc. I have stuck with the habit of mostly eating sourdough or flatbread, but have slowly re-introduced dairy and refined sugar, albeit far less than what I used to have. Since the re-introduction of these foods I haven’t had any saddles sores or other flare-ups, so I guess it is safe to say that I don’t have HS (phew).
Nonetheless, paying attention to your nutrition may be worthwhile, especially for older women. As the level of oestrogen drops off over time, so does the production of collagen (keeping the skin plumb) and natural oils (keeping the skin moisturised). Lack of collagen and natural oils can cause your skin to become thin and itchy.
Eating food that is rich in Vitamin C can help to prevent dry, itchy skin and/or repair skin damage. Omega-3 fatty acids (eg as found in fatty fish such as salmon, mackerel or sardines or seaweed) and zinc are also known to help restore (some) skin firmness. In more severe cases (and only after consultation with your GP), HRT may be a solution.
Tip 9: share
While I can only talk about what I learned from my own experiences, here is an Instagram live interview Rebecca Charlton did the other with Phil Burt about saddle sores: 40-odd minutes of priceless wisdom.
I know it can be an embarrassing subject for some people to talk about, but never stop learning from and sharing with others. What may work for you, may not work for someone else, but collectively we should continue to push for innovation and customisation when it comes to saddle and chamois design. Oh and when you find something that works well for you, buy it double or triple as you never know when it may go out of production …
As an aside, it won’t surprise anyone that most academic research on saddle sores has been carried out with male research participants. It was good to see this article looking into the prevalence, prevention and treatment of saddle sores among female competitive cyclists published in early 2020. At that stage it only included an overview of their scoping protocol, but I look forward to seeing the full research findings published soon.
I have mentioned this in my original blog, but this is important enough to repeat: if your issues persist and/or recur frequently, don’t wait with demanding a referral to a gynaecologist or dermatologist with expertise in vulvar health. I can high recommend Dr Deborah Boyle (who helped me at the end of 2018) and Dr Jane Sterling (mentioned above). Whatever you do, don’t accept your GP prescribing the umpteenth antibiotics cure !
Tip 10: care
I realise that some readers of this blog may think that all these prevention tips are nice, but what they really are looking for are tips how to (as quickly as possible) get rid of their blooming saddle sores when they have been unfortunate enough to suffer from them despite all of the tips above.
Here are some of the care tips that may work for you:
- Keep the area clean (eg tea tree oil) and dry: no underwear, no tights or anything else that restricts your skin from breathing.
- Time off the bike: one week off the bike now, may prevent recurring issues due to persistently aggravated scar tissue.
- Baths with Epsom salt can bring a boil-type saddle sore to a head and allow it to drain (don’t force it by squeezing especially not when it is a hard lump that doesn’t ever come to a head anyway !).
- Apply a product that fights infection and speeds up healing such as Tyrosur gel or Vagisil – the active ingredients are benzocaine (a local anaesthetic) and resorcinol (an antisceptic).
- Tegaderm may provide some protection and allow you to keep cycling during a multi-day trip/race if it is the rash type of saddle sore.
- If it is a softer swollen lump right on your perineum (more common in men but does also pester women), you may have what is sometimes referred to as a ‘third testicle‘ or ‘cyclist ischial hygroma‘ or ‘perineal nodule’. Sometimes time off the bike can be enough to permit the lump to shrink in size. Treatment ranges from a local steroid injection to surgical removal.
- If you suffer from hypertrophy of the vulva, i.e. chronic unilateral swelling of the labia majora you may want to avoid a saddle with a larger cut-out. Short-term relief can be found by applying ice; however, for permanent relief you likely need to address muscle imbalances and/or require an operation.
Final note: never say never
I doubt that will really be the last I have seen of saddle sores, but after nearly 20 months without any issues I feel confident that under ‘normal’ circumstance and rides up to 1200 km (with BikingMan Oman and Paris-Brest-Paris as proof), I should be fine. Sadly North Cape Tarifa (7,400km) had to be postponed until 2021. That will be the ultimate saddle sore test … Until then, fingers crossed !
Hi Fran – some tips that may help for long back-to-back rides across multiple days (which I think is what you mean with continuous day rides)
1) IF you are riding solo and can find a bit of privacy / shelter from public view for a mid-ride stop, you could use this as an opportunity to give everything a clean with a wet wipe (oh how right do the French get it with their bidets or Asian countries with their toilet hoses) let it all dry and air a bit and finally re-apply some of your preferred chamois cream. This is another reason why I like the Endura Women’s FS260 Pro DS Bib Shorts so much (and no I am not sponsored by Endura). It has a clever zipped drop seat facilitating ultra easy toilet stops. You can just let your full bum air for a few minutes whilst from the front you look fully dressed, so as long as you pick your angle wisely you could even get away with it in case of an unexpected passer-by.
2) Remove bibshorts and shower ASAP after a ride (as you already do)
3) Consider using an emollient with antimicrobial agents as a soap substitute while you shower (eg Dermol 200/500 or Oilatum Plus)
4) After your shower, once fully dry, use some cotton pads dabbed with tea tree oil (or specific acne treatment) to wipe off any lingering bacteria and then apply an emollient to soothe the inflamed skin and protect it from further damage. Sudocrem is one example. It contains antibacterial and antifungal agents and a weak anesthetic. It works well for nappy rash and bed sores and can help with spotty post-ride bum too. Other options include Bepanthen, Conotrane, E45. Natural remedies such as witch hazel, (manuka) honey, and aloe vera work for some. If indeed an infected follicle then I personally prefer Tyrosur gel but it is expensive and thus not suitable for larger areas.
5) After your ride / overnight: ‘hang loose’ ie no underwear and wear a skirt or very loose baggy shorts so your bum can continue to air.
Amazing article thank you Jasmijn! I hope your freedom from saddle sores continues long into the future. Quick query I like you am a sweaty rider and suffer from a spotty bum after most lengthy rides! I can cope ok if time in between rides but it is painful if I’m doing continuous day rides. Is there anything you’d recommend to treat this? I know if I don’t shower as soon as I finish a ride that’s fatal. I tend to use sudocreme which does seem to help?
Weer een goed, duidelijk en onderbouwd stuk! Petje af. Voor mij gelukkig geen probleem, maar ik denk dat je anderen hiermee fantastisch kan helpen.