I went to a sports medicine doc to have him look at something similar.
I’ve always got some extra chaffing on my left side. It can go from not noticeable to I feel it after every ride depending on shorts, saddle, and mileage.
A few years ago the area a swelled up. It turned out that I burst a blood vessel near my left sit bone. It was painful to ride but an ultrasound showed nothing serious. After a couple of weeks of recovery and wearing two pairs of shorts I was back to riding.
After that I started the long experiment of trying every kind of saddle as well as trying different bib shorts. I found some saddles that worked better than others and I also found that I love Assos shorts more than any others.
After a lot more analysis I’ve come to the conclusion that I sit crooked on the saddle. If you look at your friends in group rides you’ll see that most riders actually sit left or right of center. Note that the seam of bib shorts hardly ever lines up with the center of the saddle. I sit most naturally to the right which makes the left side rub more. I also don’t sit perfectly square - think about the pelvis being perfectly perpendicular to the center line of the bike. There is some degree of offset that I find most comfortable.
Solution: I force myself to sit as square as I can on the saddle. It feels odd at first but I’ve gotten used to it and all my left side abrasion/pain has mostly gone away.
For further research one can google “perineal nodular induration” or “cycling third testicle”. It has nothing to do with actual testicles but - WARNING - one may find the photos to be graphic or gross - definitely medical.
Really it’s just a fatty mass that can develop in the saddle area from the constant abrasion and in super rare cases it can get large. Probably lots of cyclists have small ones they don’t even notice and never treat.
Two pairs of shorts is an interesting idea - I may need to try that tomorrow. I have 18 miles to get to 8,000 for the year, and a ride is going to have to happen even though I’m dreading it at the moment.
I’m definitely crooked as well - my hips aren’t aligned, and I have a leg length difference, which causes some rocking and more pressure on the sit bone of the longer leg (all of that is more common than not according to my fitter). I had shims on the short leg, which for some reason caused me to over rotate the other way and weirdly twist my back. So we took the shims out after a year or so and now I’m back to the regular crooked.
I have my first appt with a doctor tomorrow - I’m hoping we can diagnose quickly and I can get on with healing.
Hi Tyson. My wife, 61, has been an avid road cyclist for 12 years, and was just diagnosed by MRI with a perineal nodular induration (PNI), also known as cyclist nodule. Physical activity is a critical part of her lifestyle and we want to be sure she gets the best possible medical care to assure she can continue cycling. We understand from our local doctors and our informal research that this is a rare condition, especially for women; and need her to be evaluated by a doctor experienced with PNI. So far, we have not been able to find one. Do you have any suggestions beyond what you stated in your 2019 post? We would be amazingly grateful for any help.
We live in south Orange County in California, but are willing to travel to assure her the best possible care medical. It seems a tele-med call may also work, so an experienced PNI doctor can be located anywhere. Please feel free to pass along this post along to anyone you think may be able to help. Thank you!
@nkipnis - No new information. Although if you live in OC then there should be several Urologists and or Gynecologists that can weigh in. I’d start by calling or asking your regular GYN, and if they aren’t familiar ask them for a referral. The territory of that region overlaps both GYN and Urology, so you may need to make several phone calls. Lastly, on the MRI if the area is small (say less than a few cm), then most would leave it alone as finding something on MRI does not always equal easy removal, nor does it always align with symptoms.
Call several GYN/URO offices and ask see if one can weigh in (or at least refer you to someone). The surgical community is quite small, and one of them will be able to point you in the right direction.
Hi Tyson, and thanks very much for taking the time to respond. Yes, this is helpful, and I compliment and applaud you on your concern for cyclists. This has been a suddenly difficult time for my wife, and it is reassuring that some information is becoming available.
Neal
Reviving an old thread as I think I have a PNI….had a saddle sore a few weeks ago and it seems to have healed with a small mass under the skin (feels like a small pea that is hard).
Friend had one removed about a month ago by his dermatologist, so I am trying to get an appointment this week.
It is not much of a bother outside at all, but inside it is a bit more troublesome. Since I will be spending the next 6 months of so in the Pain Cave (thanks, Chicago weather), I figure it is best to get this rectified now….especially since it is only November.
Last year it was a hernia, this year a PNI….good times to be had in the Fall!!
So after a whole lot or trial and tribulations, I finally had my little lump removed today….was supposed to be early December, then rescheduled to a general surgeon for last Tuesday, but had to get pushed back because my my blood was still too thin from my blood thinners.
The mass ended up being 2cm…
Feel great so far, no residual pain at all. Fingers crossed it stays that way and is not just the local hanging around.
My initial recovery was awful….I am on blood thinners and once I resumed them after the surgery, I had terrible bruising and “leakage” at the incision site. I was on bed rest for a full week and off the bike for 7 weeks total.
But that issue was a very personal issue due to my blood thinners….for the first week or so, my recovery was going very well and I had minimal discomfort. Never took as much as Tylenol.
Once I got back on the bike, I had no recurrences at the site and everything has been fine since then, even on very long rides (8+ hours).
Got it. If you don’t mind explaining your progress from symptom to diagnosis to treatment (provider type for initial symptoms, diagnostic imaging, and treatment…), and then what kind of surgeon/specialist did you go to for the excision?
I’m at the symptom phase and have an ultrasound scheduled soon. Just want to cut to the chase and limit chasing diagnoses, providers, referrals, etc. Thanks!
Started with a dermatologist, who said they could do it in office. Schedule an appt, got in and the doc did a physical exam and said “nope, you need to go see a general surgeon”.
Scheduled appt with the general surgeon, went for pre-op exam and then had it removed under general anesthesia.
No imaging or anything like that….just physical examination of the area / nodule.
It had started as a saddle sore that just didn’t heal quite right. When it healed, the hard nodule formed and it was uncomfortable in the saddle indoors. Wasn’t really an issue outside where I moved around more. As we were coming into winter, and my trainer time was gonna be increasing, I wanted to avoid any issues later in the year.
Any update on your end from this? I have a vasectomy scheduled for the end of October and my urologist also had me get an ultrasound for a “fat pad” that I have on my left side running from just under the testicle to the perineum. She revised the ultrasound and told me it was just layers and layers of built up tissue and skin. It is quite the buildup because it’s nearly 1cm thicker than the right side. She asked if I wanted to consult a surgeon to get it removed but I was unsure. I’ve been experiencing hip pain on the opposite side and I have a feeling it’s because I am sitting on this fat pad on the left. In any case, I’d be interested to hear what you decided to do.
I have a similar problem. Mine was discovered by me as a small lump on the right side of my scrotum.
Timeline day 1 - Found it after increasing load on trainer. Great fit, and solid bibs.
Timeline day 3 - Went to Urgent Care /Ultrasound and found to be 4x.5mm, so long and thin. Was told to stay of the bike for a month. Diagnosed with PNI with recent bleeding from injury.
Timeline day 14 - Not on bike since, does not hurt feels like its getting better. Cannot feel it without fooling with it. Size is the same, feels like I could carefully cycle…
