I have had perineum pain for about a year now, probably caused by an enlarged prostate gland (one of the joys of old age). The pain presents as a burning sensation then some numbness, to the point I don’t want to ride anymore. I had to quit using my brooks b17 that had been great for many years. I now ride a saddle with a large cutout and no padding in my shorts. I use compression shorts under tights in cooler weather and a regular pair of bike shorts with the pad cut out in warmer weather. I find I can ride distances again this way with no pain.