Sensitive Area Recovery

Seems like lots of questions arising over sensitive areas over the last couple of weeks. here’s another.

I noticed a swollen area in the right perineum. No pain, and really no discomfort on the saddle at all. I would think this swollen area might be caused by the saddle, but like I said, no discomfort.

I saw a digestive health dr about it. He couldn’t tell so ordered a CT scan. CT scan showed some inflammation, but this dr decided it wasn’t his area so referred me to a urologist. Urologist examined it this morning and said its some kind of general inflammation and that I should stay off the bike 4-6 weeks and until they recheck it and it’s healed.

Obviously, the 4-6 weeks off the bike struck me given I have no pain or discomfort.

So, wanted to see if you guys had any experience with inflammation such as this.

  1. Anyone have this?

  2. Any thoughts on the prescribed rest?

  3. Anyone got any additional suggestions other than rest to help it along? Such as warm soak.

  4. Any thoughts on standing workouts on the bike? I was thinking I might be able to do some climbing workouts, such as Alpe du Zwift with little to no sitting.

  5. Any tips to prevent once it heals?

Thanks much. I really don’t want to do nothing for 6 weeks if I can work around it.

Could be related to this discussion?

I read that thread in detail, but I don’t have any nerve pain or discomfort at all. It sounded like what they were describing was quite painful so It didn’t seem like the same.

1 Like

I’ve had the exact same thing for the last year and a half-ish. Hasn’t gotten worse or better so I haven’t changed anything. Probably not the best advice, but it doesn’t hurt or get bigger based on my training volume.

I had a cyst that was painful and uncomfortable after not really bothering me for a while. It was resolved very quickly with a cortisone shot. Maybe you’re in the beginning stages of the same issue. :man_shrugging:

my next appointment will be with infectious diseases to find out if it’s something that needs to be treated with antibiotics. I’m sort of hoping this is the case because I’m not supremely confident that rest will take care of it, but the CT scan showed no abscess or anything like that, so it’s doubtful. Glad to hear yours isn’t getting worse. Mine never seemed to get worse either with the exception of it was another friction point for the occasional saddle sore.

My urologist was concerned that if I did not rest it, it would a) get infected and/or b) would somehow separate (not sure what medical term he used) and might require a significant surgery to correct.

I rode this morning on the trainer and did Alpe du Zwift standing up completely. Was better than nothing. I might have to suggest to Chad to create a new workout for standing work only.

I’ve had the same kind of inflammation at times over many years of riding. It often LOOKS like it should be painful or a problem, but it seems to just be general inflammation like your urologist said. Even with a optimal saddle and position, you still get subjected to a lot of pressure and impacts there which would naturally lead to some swelling. Mine never gets worse - it just becomes another cyclist idiosyncrasy for my wife to make fun of.

If it isn’t bothering you or showing obvious signs of progressing to a cyst or infection (hardness, pus), I would just keep an eye on it and not stay off the bike unless it becomes an issue. For me, the biggest consideration is watching for additional friction from having additional mass moving around down there.

I had something similar, swollen lump on the right hand side of my perineum. However it wasn’t excessively painful, though I am always paranoid of anything that is out of the normal in that general region. At first I thought it could be an ingrown hair, but it doesn’t seem to be the case.

As far as I can tell, it seems to be triggered when I wear my older bibs on the trainer. If I use my newer bibs, it seems to be fine. I really need to throw away those old bibs…

1 Like

Lipoma, maybe? I have a few of those.

2 week update on this.

I’ve been “technically” off the bike for 2 weeks now. I’ve been doing a bit indoors, but only standing work, until recently I got a noseless saddle that has nothing going between my legs.

The swelling seems reduced. Not gone, but reduced. The fact that is has reduced seems to confirm that it’s at least sustained by cycling. I will keep doing what I’m doing for another two weeks and will take a check then.

Quick update on this for those curious.

I completed my 6 week hiatus where I pretty much cut my biking in half and the biking I did was standing up and not aggravating the issue.

What I saw was that the swelling reduced, but not completely. Not sure if 6 weeks was enough. I went back to the Urologist and he said it looked better and that I could ease back into it and come back in 3 months. All good, had my first two outdoor rides last weekend. awesome.

In the meanwhile, I measured my sit bones and found out my sit bones were about 120mm, which seems pretty wide. Given my bike came with an Arione, which is only about 128mm, I’ve decided I need a much wider saddle. I purchased one that is 146 mm and we will see how it goes!

1 Like

…while it has been some time since your initial post I have some information that may help for those in the future. My background: Emergency Physician for over 10 years, BS in Exercise and Sports Science, and I race road/cross.

Some definitions first: A nodule is a firm mass of tissue that is easily palpated and has relatively decernable location (think a marble under the skin). A cyst is a fluid filled sack (usually non-infectious like a water balloon) while an abscess is similar to a cyst (fluid filled), but that fluid is bacteria and byproducts of cellular breakdown (infectious). Induration is firmness of the soft tissue, and ulceration is loss of the top layer(s) of skin.

The perinuem is the space between the back (posterior) aspect of your genitals (scrotum or vulva) and the beginning of the anus.

Swelling in the area can be from a multitude of problems but the most common is going to be some form of induration and/or slight ulceration from either ill fitting shorts, poor fit, poor hygene, or inappropriate lubrication (most likely combination of all). This is most easily avoided by addressing the aforementioned causes, rest from the bike seat, and allowing the tissue to heal. A bad ulceration of the area would be a “saddle sore” although this term is ambiguous and used freely to describe pretty much anything wrong the area.

Next on the list (if you continue to cycle) is going to be the formation of an abscess. As the skin surface is broken down (ulcerated), you have lost your skins protective barrier against bacteria. Bacteria in the area gets below the upper layers of skin and form a small pocket of pus (abscess). In an effort to “fight” the infection your body creates an immune response that causes swelling, significant pain, and induration to the area (similar to a giant zit). Abscesses need to be opened by scapel and drained the vast majority of the time. Very rarely will they get better with just antibiotics. After draining, you’ll need to rest (1-2 weeks off the saddle), and once again address the issue of fit, bibs, lube, etc.

Next are several of the uncommon in the literature but more common than you think issues. Ischial Hygroma/Cyclists Nodules (perineal nodular induration - PNI). A hygroma is a fluid filled sac (similar to a cyst) that occurs from multiple micro trauma to the area, and usually is secondary to a poor fitting position and saddle. These are lumped into the same category as Perineal Nodular Induration (Cyclists Nodule, Bikes Nodule, or “third testicle”). The downside of Cyclists nodule is that you can try a steroid injection which may decrease the swelling, but the actual fibroblastic spindle cell tissue mass stays in place and can recur… so the recomendation is for resection. For further reading see here: https://www.ajol.info/index.php/sasma/article/viewFile/184227/173599

A firm nodular mass on one side of the perineum (marble under the skin) that isn’t significantly tender but rather an annoyance and mild irritation think more along the lines of Cyclists Nodule. This would be need to be addressed by your Urologist, a good colorectal surgeon, or a good gen surgeon.

On the other hand, a red, inflamed, very tender mass that dosn’t have very defined edges is more likely abscess/cyst and can be drained by any good primary care physician.

I hope this helps. I wish it was as simple as “swelling = do this”, in summary it’s a bit more complicated. Last asterisk to the conversation, there a many other things that are much less likely but possible, see your doctor for further evaluation.

7 Likes

@tysoncook thanks so much for sharing this information. It’s more than I’ve found anywhere else. I have had relatively mild issues with ulceration on and off over the last few years. The occurrences have always healed quickly using hydrocortisone creme and/or antibiotic ointment. Recently, I’ve had a more persistent round that has culminated in a nodule under the skin (I’m actually not sure if the nodule was there first and the ulceration was due to chafing around it or if the ulceration came first - I’ve never really had to worry too much in the past so other than slapping some cream on it, I didn’t pay attention). The nodule got my attention about 2 weeks ago. It is oblong and pretty hard. It’s not exactly tender, except for during and after a ride. The pain during the ride is very bad, and after a ride it’s tender and the surrounding skin is as well. I’ve taken 3 days at a time off the bike the last two weeks. The skin calms down during that time, but the nodule doesn’t seem to be going anywhere.

I did start antibiotics hoping that would help if there is an infection. Im a few days into those and now having read more in forums on this topic, I’m nervous that’s not enough and I need to do more. What kind of doctor should I see about this? Because these cycling related issues aren’t well known, I’m nervous about finding someone that can help. I am also going to try a different saddle and have ordered a rocking plate for my trainer.

Any advice or insight you can provide would be so appreciated!

I just had a cyst removed and it really sucks. I saw a dermatologist and got a second opinion and they said after the draining it could come
back and the flair up again. The first flair up was 3 weeks off the bike and I could still feel the mass while riding after 6 weeks from
Initial Damage. Worst part is I didn’t get it while
Riding a bike rather remote camping. Due to ripping the stitches it will be 6 weeks off, hope yours doesn’t flare up in the future. Try to limit shaving in that area

1 Like

I had it come back once more, but after another cortisone shot, haven’t had any issues since then. Been at least a year and a half, maybe longer.

1 Like

I was worried about a flair up mid season. I think opting out would have been a better option. I had a total of 4 doctors tell me to get cut, mine was a 6mm mass

:flushed:

That must have hurt like a mofo.

I would start with your primary physician. They may be comfortable aspirating and/or ultrasound to get a better idea of what is going on. If they are not, then your Gyn would be another great starting place. Hope this helps.

Of note, in reviewing others perineal problems, it seems that the trainer is a big culprit… be careful and make sure your standing fairly frequently

2 Likes

Thank you! I agree that the trainer makes it worse. I am forced to use it for convenience (daylight and babysitting are limiters, esp in the winter). I’ve not had trouble with long trainer hours in years past, but I know the body changes over time. I have had good bike fits, but not done saddle pressure mapping. I will look into that as well.

@TonyLPowell I am going to ask about a shot.

1 Like