Name: Scott Morris
Location: Nomad, western US
Primary type of riding: Mountain, bikepacking
Riding specialty: Technical climbing, long distance, hike-a-bike, “dumb” rides
Years of riding experience: 30
When did symptoms start: At age 34, 10 years ago
What did initial symptoms feel like: Sharp pain in the perineum at first, then general dull groin/pelvis pain
If known, presumed causes of pudendal neuralgia: There are two possibilities: cumulative and acute. It was probably both. The cumulative side is general abuse from very long rides (e.g. bikepacking races of 3+ days),and from my love of technical climbing, in which the saddle angle and frequency of obstacles causes frequent jolts and mild trauma to soft tissue. The acute side was a 20 hour ride where my back was very sore, so I ended up sitting towards the front of the saddle, descending while sitting on my perineum, essentially. Nothing hurt until about 10 days after this ride. Prior to this ride I never had any significant issues with numbness or pain outside of standard saddle sores.
Amount of time off the bike since injury: 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 things 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.
Symptoms: My primary symptom has been a pain in the pelvis/groin area, only on one side, sometimes extending to one testicle. It's mostly a dull ache. 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/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: perineum, anus, penis, testicles. I experienced some urinary symptoms as well, enough that I suspected a UTI for a brief time. 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 9 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.
Treatment: The main thing for me is 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. So the primary treatment for me has been to ride with a saddle that bears no weight on the perineum, even when climbing steeply.
Recovery Status: I wouldn't consider my recovery complete but I have learned to live with the condition. For some years my symptoms have been almost completely gone and I don't think about it very much. But recently I tried a really comfortable saddle that does have a nose (and cutout for perineum) and after initial excitement that it seemed to be 'working', the familiar ache on the one side returned (after some delay). There are enough downsides to riding with noseless or snub-nosed saddles that I would love to be able to ride a normal saddle again, but I am not sure that I ever will.
Are you riding again: Yes. 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 many other multiday or very long day rides. I have competed in a few races in the last 10 years, as well.
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. I'm as obsessive of a cyclist as they come: starting to ride daily as a 13 or 14 year old 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 this very stress/anxiety.
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.
If anyone wants saddle advice in this area, feel free to contact me, especially for mountain biking. Here's a summary of what I've learned:
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. Modern bikes have dropper posts which alleviate this to a large extent: it is 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 no matter what I can always ride 80% of what I want to
ride.
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, so they make it easy to quickly shift your weight to get behind them. The two sides that you sit on at the front of the saddle should be positioned directly under the ischial tuberosities (sit bones) so that very little of your body weight is on soft tissue. 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! So, what's the downside, then? I have not been able to find or set one up that is comfortable enough for long rides. After 6+ hours my sit bones get sore, or I start to experience numbness on long climbs. I've also 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 am 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.