Perineal Nodules Caused by Bicycling

A 62-year-old man presented with pressure-sensitive swellings in the perineum. These had initially recurred after biking but had more recently grown in size and become permanent. The history and clinical findings pointed to the diagnosis of “biker’s nodule” (perineal nodular induration). This is a usually solitary, in our patient bilateral, firm subcutaneous nodule in the perineum. The causes are local pressure and repeated microtrauma, principally from extensive bike riding. The treatment of choice is a break from biking; alternatively, a gel saddle can be tried. Treatment with intralesional corticosteroids or hyaluronidase can be considered in particularly severe cases. Surgical treatment is feasible but should be used sparingly because of the high likelihood of recurrence and the poor pressure distribution resulting from scarring. This benign pseudotumor can be diagnosed at a glance. It should be familiar to every practicing physician, thus sparing the patient unnecessary examinations.

Translated from the original German by David Roseveare.

Cite this as: Scheiba N, Hartschuh W: Perineal nodules caused by bicycling.

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