masi61

Just wonder if anyone has heard of this condition.

I have 2 grape sized hard subcutaneous nodules on the left/central perineum at the base of my scrotum.

The one one closer to center is more painful but both feel kind of “pinchy”. These little bits of scar tissue have a lot of nerve endings in them. They can get really “angry” and go from pea sized to grape sized to (small) egg sized when inflamed.

I found the term “Perineal Nodular Induration” or “PNI” while doing a web search on this condition.

I have had saddle sores that were from infections such as infected hair follicles but these nodules do not resemble those. It seems more like a pinch in the perineum has led to subcutaneous scar tissue perhaps from poorly fitted shorts or “riding the rivet” or nose of my saddle too much. I used to be heavier and I am 58 now so my so I do have some loose skin in this area. I am pretty consistent about applying Queen Helene Shea Butter body creme to his region prior to embarking on my 2 to 3 hour training rides and it helps some. Now that my season has progressed, I am more fit so I am able to use my abdominal strength and shove my ass furtherback on the saddle and ride the drops a bit more to lessen the forward pressure. I like my Turbomatic Team carbon saddle - it is long and firm but does have elastomers under the rails and I intend to keep them on both my active roadbikes.

I plan to reach out to my family physician for him to check these 2 painful perineal nodules. I’d like it if he would be willing to try injecting some cortisone into both of them to try to reduce the inflammation, thus softening them. If this does not work, I might be seeking a surgical referral to have the 2 spots excised.

Has anyone experienced this rare, Nodular type of saddle sore?

OldTryGuy

Logical action.

Carbonfiberboy 

I've had a spot like this on the right side for several years. This year, seeing that all my event rides would be cancelled, on May 12 I went to a dermatologist who injected 1/2 cc of Kenalog 10, This resulted in a severe skin ulcer which has finally begun to heal. Prognosis is at least another month before I might possibly be able to ride again. I can't sit on it at all, sitting only on a doughnut cushion to keep pressure off the ulcer which also has to be protected by a dressing I change every day. Thus I haven't been able to ride since early May and it's unclear when I might be able to sit on a saddle again. Also, it looks like the lump is still there, though much smaller, and the skin quality in that area is much worse, sort of loose and weird looking. In retrospect, I should have gone for the surgery right off. This was a complete disaster. I'll probably still have to have the surgery.

canklecat

Yeah, I've occasionally developed those nodules the past year. It was immediately noticeable so I made a few changes as soon as I felt a small pea sized lump.

I use an ordinary barrier cream (zinc oxide, menthol, etc), switched shorts and saddles, waited a day or so for it to subside. So far, so good. It threatens to return once in awhile but the barrier cream seems to keep it in check for now.

A minor tweak in my bike fit may have helped as well, by reducing pressure on that particular point. I switched from a 90mm to 110mm stem. Along with a different saddle, it seems to have changed pressure points just enough to eliminate the problem for now.

I suspect the saddle was the main culprit. I was a saddle with a large perineum relief cutout and flexible shell. But by eliminating pressure on the perineum my weight had to go somewhere else. So there was more pressure on a tendon or ligament, where the nodule developed. Switching to a more conventional saddle seems to have helped. I didn't really need the cutout saddle, I just decided to try it last year. Seemed okay for awhile but wasn't really any more comfortable than a solid top saddle or one with a smaller relief cutout.

masi61

Carbonfiberboy - so sorry you are having this issue. I am beginning to think it is much more widespread than anybody knows.

I'm wondering what specialty surgeon could remove these lesions? Since it is pretty deeply subcutaneous, I doubt that my dermatologist would want to excise one (or two) like I need.

masi61

canklecat - your experience sounds similar to mine. My Team Turbomatic saddle has no cutouts. It is a bit longer than a lot of short modern saddles. I think riding a cutout saddle would not help anything for me. I do much better being able to slide forward a bit or all the way back depending on the terrain.

How my 2 left sided nodules got started I want to say started back at the beginning of this season wearing thermal bib knickers. I had a pinch of loose skin that I thought would work itself out while riding. I must have forgotten the barrier cream that day. Usually a healthy smear with the Queen Hélène stuff and you can feel your butt smoothly contouring itself to your shorts chamois pad. This one pair of thermal knickers (the Voler ones I think, not the Pactimos has more of a “grabby” seat pad) - too bad they don’t make silk short liners.

Anyway, the little painful nodules are here now and my job is either how to minimize the discomfort (like you apparently did) or set out to find a way to get rid of them completely. Nerve endings that you have cut out worry me though. I had Morton’s Neuroma surgery on my left foot and my left foot post surgery still experiences all kinds of pain, numbness, hotspots intermittently.

Carbonfiberboy 

Thing to do is ask. Mine said he would if it came to that, though I'm not sure he meant him personally. They do a lot of fancy cutting though.

JanMM

No personal experience with your issue, but do know that some dermatologists do highly specialized procedures. Or, '..fancy cutting..' as carbonfiberboy said.

masi61

The larger, more central of these 2 nodules goes deep under the skin - almost down to the pubic bone. I will tell my dermatologist about it when I go in for my annual skin check with him this month.

masi61

I was hoping to hear from other bikeforums.net members who maybe had surgical excision of these PNI nodules and ask how the procedure went for them. I'm still being vexed by this and they seem to be getting worse not better. This is frustrating because I'm just past the mid-point of the cycling season where my bike fitness is quite good. My average speeds and/or my overall enjoyment of my rides has been impeded by the pinching pains from these d#mn nodules, the bigger of which is starting to bleed now.

OldTryGuy

Just thinking that a Gastroenterologist or a Urologist might be familiar with this issue.

Carbonfiberboy 

I'm almost healed now, things are looking better. Skin there now seems like it might be OK after all. Maybe another 2 weeks until I can test it. Of course there's the chance that it might happen all over again. However, these things first appeared when I was using a saddle which was too narrow. I'm keeping my hopes up. I've been running and walking and lifting while this has been going on. That's been interesting, too.

Bummer #2 is that my bike was what was keeping my back strong, so all of a sudden I got sciatica. What next? I think I have that figured out now, too. Need the right combo of stretches and workouts.

metalheart44

I have an appointment with a Sports medicine / Family doc in a week or so to check what I believe is a PNI. I have had some discomfort/pain during and after rides for multiple months, most an aching pain on my right sit bone. It is uncomfortable while driving and sometimes while sitting. It also can be worse after a ride. About a week ago while I was putting on chamois cream I noticed a small nodule on the right side of my perineum but not the left. Did some internet sleuthing and discovered PNI as a potential explanation so I made an appointment with the doc. Then I remembered that some months ago I made a change to saddle position that is the most likely explanation for my pain. I thought this was just some other type of muscle/soft tissue issue untilI discovered the nodule. I have changed my saddle position back to where it was before and the discomfort seems less while riding. I am hoping that surgery is not the solution, but whatever happens with the doc happens.

masi61

This is interesting: I have never used a cut-out saddle. I intend to try one soon. I really love my Selle Italia Turbomatic team carbon saddle without any cut outs. I plan to bid on the same saddle (on eBay) but with the cut out relief channel. I took a week off from riding then went for my normal 42 mile training route on Monday. Unfortunately, I was in a lot of "pinchy" discomfort from this nodule right at the base of my scrotum (but not on the scrotum). My appointment with the urologist is not for another month. I love riding but right now I'm a bit depressed because riding aggravates this condition.

masi61

Hey, I'm just following up. After reading your post I was wondering if you made it to the doc and what his recommendation was? I still have not made it to the doc but man this nodule is super sensitive making me have to shift some of my weight to the right (the nodule is center/left). I have learned the importance of taking care of all 3 points of contact (the seat, the hands and the feet). Using abdominal strength and the hands/arms to unweight my ass does seem to help reduce the pressure somewhat as does running lower tire pressures. But these interventions are only stop gap right now since the one subcutaneous nodule that I have feels exactly like a sharp skin pinch (without an actual external skin pinch). I have noticed some pink serous drainage on my synthetic chamois pad following my rides lately and I also saw some blood stains on my sheets from this general area. Strange thing is, I don't see much of any surface wound. It is more like a prune sized knarly lump under the skin right in that spot. I also have a second nodule on the left side of my outer scrotal area that is benign in that it is not inflamed, enlarged or painful.

Carbonfiberboy 

Exactly like that. Mine eventually did the same thing, blood on the chamois even though I've always ridden with lube. I've been to Dr. Google. Looks like excision is the standard treatment. Neither my PCP nor dermatologist had ever heard of it. Triamcinolone cream and Mupirocin antibiotic (both prescription) will help, but not fix.

masi61

Thanks for your reply. You're just googling the condition? What about the MD appointment (surgeon, or urologist)?

Carbonfiberboy 

My PCP never heard of it, though he prescribed meds to help it, and the dermatologist misdiagnosed and them maltreated, which has caused me at least an additional 2 months off the bike. I couldn't google it until I saw it described here!

metalheart44

I had the appointment today with a sports doc and she is also a cyclist. She quickly confirmed my suspicion that the subcutaneous lump I have on the right side of the perineum is a PNI. She also did some manipulations of my legs/hips and her opinion is that my post-ride discomfort may be either piriformis related or possibly siattica. t could also be related to the PNI. We talked about an injection for the PNI, but she said her experience is that it tends to be messy and often not very successful. She said that surgery might be an option if the PNI is the primary source of the pain. For now, the plan is to do some PT and see if that can sort out the sciatic or piriformis possibilities and then follow up in a few weeks.

In the interval between making the appointment and seeing the doc today I adjusted my saddle about 5 or so mm forward so I was sitting on the wider part of the saddle. I have done a number of rides since then, including a couple longer (50+) rides without only minimal discomfort during the ride. Pain and stiffness post-ride is still there, but not to the degree that it was prior to this saddle adjustment. The PNI is clearly there, but it is less clear if this is the cause of my issues or not. I have no drainage or opening in the skin (she asked if I had looked at it and I described how I used my tool box flexible mirror too examine the area --- she was amused).

So, the PNI is still in play but so are some other possible issues.

Carbonfiberboy 

IME saddle shape and position on the saddle cause or do not cause a PNI. Go for a ride in nylon shorts. That might help make things clearer. The pad can cover a host of sins.

My injection-caused skin ulcers have now cleared up enough that I can tell that the PNI is still there, underneath, though much reduced in size. My current saddle is a much better fit for me, so I'll see what happens.

masi61

Just wanted to post an update. I went to the urologist a couple of weeks ago. He was able to palpate the nodule in the "taint" area. He agreed that a surgical procedure to excise it is doable. I mentioned that I did not want the down time in my cycling season just yet and that for insurance reasons January might be a good time to have the elective outpatient surgery.

He wasn't real impressed with me calling it "PNI" or "Perineal Nodular Induration". He said it was an inflamed sebaceous cyst. I told him that it occasionally has pink thin drainage, but no pus. He repeated that that was consistent with a "Sebaceous Cyst".

Regardless of what you name it, this nodule or cyst is right under the nose of the saddle and it gets ANGRY quite easily even with the best bike shorts/knickers. I do notice that my knickers which I really like wearing in the cooler weather seem to trigger this "pinchy" feeling a bit easier than good bib shorts do.

masi61

Another bump on this thread for a further update:

I now believe that the nodule I have been experiencing is indeed an infected Sebaceous Cyst with clogged sebaceous glands. I'm beginning to think that my use of ample amounts of "Queen Helene" Shea Butter body crème might be partly responsible for blocking the duct.
I have been apprehensive about potentially getting a small surgery to remove the nodule so I did an experiment based on something I read about on the internet. I applied organic apple cider vinegar to a cotton ball and then covered the nodule with a large fabric bandage. I then left the bandage on for an entire day. I rode 42 miles with it in place. I thought I made things worse because in the days following doing this, the pinching sensation was still there but now I also had some tingling/burning and also now had 2 little pimples opened up and were coming to a head. I removed the bandage that night and soaked in a warm tub with some Epsom salts.

I think the apple cider vinegar actually may have stimulated the cyst ducts to start draining the cyst.

So today, I am starting another cotton ball soak, this time with tea tree oil and hydrogen peroxide. My hope is that the antibacterial, and antifungal properties of this saturated cotton ball will wick down the ducts and into the cyst helping to open up and drain as the inflammation starts to subside. I am hopeful that this will work, at least partly. I went riding for 2 hours yesterday and I would say that while I could still feel the nodule and feel the pain, it is now more of a dull pain and the pinching pain has lessened some.
Because of where this nodule is located, I am also planning on trying a different saddle, this time a Fizik Antares VS with the central channel depression. I really don't want to get the surgery for cost reasons. Also, the urologist was not willing to do an excision and drainage in the office, instead he is talking about it being turned over to a general surgeon and me having to go under general anesthesia for this.

So if you have read this, I thank you for paying attention. Please feel free to comment on my use of the apple cider vinegar, tea tree oil, and hydrogen peroxide. I am greatly encouraged at this point and while the acid from the full strength apple cider vinegar did cause some burning, I think I may have actually gotten the subcutaneous cyst to take in some of the vinegar and thus led to the clogged sebaceous ducts to exude some nasty yellow waxy stuff and start the process of softening and becoming un-inflamed for a change.

hsuBM

I definitely have only had problems with cutout saddles. They’re pointless for my skinny male body with somewhat protruding sit bones. I wind up with rubbing (feels like cutting) down there. By contrast, my basic Brooks Pro feels about perfect most of the time and my Fizik Arione Classic and Tri2 feel like a cycling-optimized version of the chairs in grammar/middle school upon which I could sit for hours without developing sores.

Best wishes with the doctor.

masi61

Yet another update on this last update from about a month ago. I went ahead and cancelled my follow up appointment with the urologist. The above mentioned treatments have had good results! I really do not intend to seek minor surgery in this part of my body, especially since the organic apple cider vinegar treatment was quite successful. The outline of the cyst is still palpable but it is now mostly flat and now mostly pain free. Using alcohol wipes to cleanse the area daily, hypertonic epsom salt soaks and my newly revised apple cider vinegar poultice/compress seem to have gotten the sebaceous ducts unclogged and allowed the cyst to evacuate the waxy clog that had bedeviled me for this past year.

Too bad outdoor temps are now down in the 20’s and 30’s or I would be resuming my road riding right now. I did do 3 rides outdoors last week and they went well.

My trick method of applying the organic apple cider vinegar involves using a fresh turmeric rhizome that I had on hand in my kitchen. I sliced a full length slab of the turmeric and soaked it in the vinegar. I then applied the vinegar soaked turmeric directly to the affected area and (sorry if this description is a bit gross) held it in place just by the weight of my butt cheeks and my underwear only, no dressing required. The longer I could keep it in the correct spot, the more the active ingredients in this concoction had the opportunity to work. I will definitely remember this method and utilize it again in the future should this cyst become “angry” again.

I would welcome any follow-up questions that folks may have about my (admittedly odd) home remedy. I did obtain the Fizik Antares VS saddle with the center channel (2 of them, both used and in great shape for ~$35 each BTW) but presently I am happy again on my favorite old Selle Italia Turbomatic Team Carbon saddle.

jppe

Glad you are getting some relief and are making progress. I’ve had a huge hard knot in front of my right sit bone for years. It’s very deep under the skin, it almost feels like it’s in the tendon area it’s so deep. I think mine was caused by a combination of a bike frame that was too large combined with a saddle which had letter stitching just below where the sit bones would rest on the saddle. It’s normally about 1/2 the size of a golf ball but will double in size after riding and get harder. Fortunately there’s not a lot of pain from it but it can cause discomfort if it gets under the sit bone while riding. I can slightly slide around on the saddle to reposition if needed. I’ve gotten where I don’t notice it much anymore.

When it first surfaced I told my Orthopedic doctor about it. He took X-rays and immediately made me an appointment with a cancer specialist. The specialist was puzzled as to what it might be but after quizzing me about my riding he felt like irritation was the cause. He took my case to a panel of doctors which meet weekly to discuss patients issues, treatment etc. and the consensus was the lump was activity related. He said he’d be happy to do surgery to remove it but I was doing a lot of riding at the time and didn’t want to lose the conditioning from all the time off the saddle. He told me if there were ever any significant changes to let him know.

When I had my right hip replaced two years ago I told the surgeon about it and asked if he could remove the lump while he already had me opened up and on the table. It made perfect sense to me (I was on morphine from the broken hip) and shouldn’t add to my recovery time!!!! He wasn’t keen on the idea and said he wasn’t going to be anywhere near there replacing my hip and brushed it off. Oh well, I thought he might just be able to take a little detour while he was working on my hip. I was more curious about having it out just to see what it was and what it looked like.