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.

Patients treated for vulvar carcinoma may experience losses in mobility and physical activity. In this study, we assess the prevalence and severity of mobility problems using patient-reported outcomes of three questionnaires: EQ-5D-5L to estimate QoL and perceived health; SQUASH to estimate habitual physical activity; and a problem-specific questionnaire on bicycling. Patients treated for vulvar carcinoma between 2018 and 2021 were recruited, and 84 (62.7%) responded. The mean age was 68 ± 12 years (mean ± standard deviation). Self-reported QoL and perceived health were 0.832 ± 0.224 and 75.6 ± 20.0, respectively. Dutch physical activity guidelines were met by 34.2% of participants. Compared to baseline values, the times spent walking, bicycling, and participating in sports were all reduced. During bicycling, patients experienced moderate or severe pain in the skin of the vulva (24.5%), pain in the sit bones (23.2%), chafing (25.5%), or itching (8.9%). Overall, 40.3% experienced moderate or severe bicycling problems or could not bicycle, 34.9% felt that their vulva impeded bicycling, and 57.1% wished to make more or longer bicycling journeys. To conclude, vulvar carcinoma and its treatment reduce self-reported health, mobility, and physical activity. This motivates us to investigate ways to reduce discomfort during physical activities, and help women regain their mobility and self-reliance.