Meet Scott
Mostly Symptom-Free
Riding with Adjustments
MTB & Bikepacking
Riding Type
Technical climbing, long distance
Riding Speciality
One-sided pelvic & groin pain
Primary Symptoms
High-volume riding combined with a single 20+ hour ride
Likely Cause of PN
How it Started
My symptoms started at age 34, about 10 years ago. Looking back, the event that seemed to trigger everything was a 20-hour ride where my back was very sore. Because of that, I ended up sitting toward the front of the saddle and descending while essentially sitting on my perineum. Nothing hurt immediately, but about 10 days after that ride, symptoms began. The initial sensation was a sharp pain in the perineum, followed by more general dull groin and pelvic pain. Prior to this, I never had any significant issues with numbness or pain outside of standard saddle sores.
Symptoms
My primary symptom has been pain in the pelvis and groin area, only on one side, sometimes extending to one testicle. It’s mostly a dull ache.
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During the first year of figuring this out, I had many other symptoms. I had not figured out how to ride with a noseless saddle, and I kept riding after rest periods of different lengths. I was visiting doctors and generally experiencing stress and anxiety over the situation, not to mention grief at the loss of being able to ride - something that was so important and such a part of my identity. I fully believe that the stress and anxiety contributed to worsening symptoms.
During that first year, I had much more sharp pain that would move around and include other areas served by the pudendal nerve: the perineum, anus, penis, and testicles. I experienced some urinary symptoms as well, enough that I briefly suspected a UTI. I also had some issues with erectile function, but I attribute that mostly to the mental side. I never had issues with erections before this and haven’t since (in the last nine years).
During that first year, I was also uncomfortable wearing tight clothes and sitting for long periods, especially on hard surfaces. I still can’t sit for too long on hard surfaces.
Causes
I believe my pudendal neuralgia developed due to a combination of cumulative and acute factors.
On the cumulative side, there was general abuse from years of very long rides, including bikepacking races lasting three or more days, along with my love of technical climbing. The saddle angle and frequency of obstacles during these rides caused repeated jolts and mild trauma to soft tissue over time.
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On the acute side, the 20-hour ride described above likely pushed things into a more persistent nerve issue.
What Helped
The main thing for me has been avoiding any significant pressure or trauma to the perineum. That’s easy to do in normal life, but not so easy when riding a bike, especially a mountain bike. The primary treatment for me has been riding with a saddle that bears no weight on the perineum, even when climbing steeply.
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I’ve also taken extended time off the bike. It’s been a bit of a long road. Like others on this site, I quickly discovered this wasn’t something I could just take a few days or weeks off the bike and have it resolve. I’ve gone months without riding, picking up activities like running, hiking, canyoning, and packrafting. Symptoms always improve, but if I spend any time riding with a normal (with a nose) saddle for any extended time, they return.
Current Status
I wouldn’t consider my recovery complete, but I have learned to live with the condition.
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For some years, my symptoms have been almost completely gone, and I don’t think about it very much. More recently, I tried a really comfortable saddle that does have a nose (and a cutout for the perineum). After some initial excitement that it seemed to be “working,” the familiar ache on one side returned after some delay. Because of this, I’m not sure that I’ll ever be able to ride a normal saddle again.
While noseless or snub-nosed saddles have their downsides, they’ve allowed me to keep riding.​ Using various saddles, I’ve been able to log thousands of miles in all sorts of conditions. I completed a 4,000-mile technical singletrack ride across the US on the Continental Divide Trail, toured on mountain bikes for months in New Zealand, and completed many other multiday or very long day rides. I’ve also competed in a few races over the last 10 years.
Saddle Learnings
There are two types of saddles I can use. One is fully noseless, where you sit or lean against large pads. All of your body weight is on your buttocks - a part of the body designed to bear weight. The saddle I’ve logged thousands of miles on is called a Spiderflex. This is a great saddle for touring and roads but has a major downside for serious mountain biking: you can’t open your legs wide enough to quickly shift your weight behind the saddle.
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Modern bikes have dropper posts, which alleviate this to a large extent - it’s easy to get your weight back for even the steepest terrain. However, I still find it difficult to ride undulating trails where you are climbing steeply, hopping over obstacles, and alternately dropping steeply. I was able to bikepack the 4,000-mile CDT with one of these saddles, and the CDT is a rugged and steep route, but bikepacking for me is a more conservative and slower kind of mountain biking. For aggressive day riding, this type of saddle is not ideal. I rest easier knowing that this saddle is always there and that no matter what, I can always ride about 80% of what I want to ride.
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For aggressive riding, I’ve found success with snub-nosed or forked saddles like the ISM line or the newer Bisaddle. These saddles are narrow and shaped like a normal saddle, which makes it easy to quickly shift your weight to get behind them. The two sides you sit on at the front of the saddle should be positioned directly under the ischial tuberosities (sit bones), so very little of your body weight is on soft tissue.
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These saddles are excellent for technical climbing because you can shift your weight forward and sit firmly on the front edge, allowing good control and no trauma to soft tissue. They are better for technical climbing even if you don’t have issues with pudendal neuralgia.
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So what’s the downside? I have not been able to find or set one up that is comfortable enough for long rides. After six or more hours, my sit bones get sore, I start to experience numbness on long climbs, and I’ve had more issues with chafing and saddle sores than usual. Again, this is only for long rides - I think these saddles are great for shorter rides. I’m still looking for the perfect saddle. I’m not really sure what that looks like, but I hope the cycling industry keeps pushing this forward.
Personal Note
I’m really happy to see this site and others sharing their stories here. I want to thank Kate for all her work and for sharing her journey. Information about this condition is still pretty limited, and it certainly was 10 years ago when I was googling and finding very little. I have deep sympathy for those going through the early stages of figuring this out.
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I’m as obsessive a cyclist as they come - starting to ride daily as a 13 or 14 year old and then pushing it further and further with XC racing, 100-milers, 24-hour races, and bikepacking races. I created the first bikepacking race on singletrack and have organized a number of other races over the years. Riding a bike is important to me, and I know how difficult it is to face the possibility of never riding again. It’s interesting how this condition can get worse due to stress and anxiety.
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I hope that my story offers some hope to others in this situation. Even if it doesn’t go away, it can be manageable, and many rides are still possible. It was a bit of a mental hurdle to get over riding with goofy saddles that some people fear signal that you “have a problem.” My experience has been that most people don’t even notice or care. When people do notice, they are often interested because they have an issue riding normal saddles and see an alternative. I’ve gotten a little bit of ribbing from my friends, but it’s always been good-natured. I wouldn’t let fear of embarrassment deter anyone from riding a saddle that works.