Perineal pain limits sitting and bicycling comfort in women with chronic vulvar conditions, reducing functional mobility and physical activity. This study evaluated personalised ergonomic saddle solutions to reduce perineal pain and restore cycling ability. Fifty women (age 57 ± 14 years) with lichen sclerosus, lichen planus, or vulvar cancer participated in a pre-post intervention study. In an outpatient living lab setting, participants evaluated four cutout saddle designs, received posture advice, selected a saddle, and tested it at home for 1-3 months. Outcomes included saddle pressure and centre-of-pressure metrics, trunk tilt, bicycling-related symptoms, quality of life, physical activity, user satisfaction, and personal goal achievement. A reference group of 50 healthy volunteers evaluated the saddles in the outpatient setting only. Pre-post cycling impediments (moderate or worse) decreased from 76.0% to 30.4% (p < 0.001), with marked reductions in perineal symptoms. Saddle design influenced centre-of-pressure location and variability, particularly in the anteroposterior direction. Seventy percent of participants achieved their personal bicycling goal. No changes were found in overall quality of life or physical activity. To conclude, personalised saddle selection reduces perineal pain and improves cycling ability in women with chronic vulvar conditions.