The number in my screen name reveals my birth year. I often qualify posts with my age since riders 30-50 years younger than me will simply not address issues the same way I do nor will they have the same issues. I don’t view myself as anything special by being on the bike at my age. I just like to ride. That being said, the topic of this thread used to be a significant limiter for me (the last 10 years). Regarding resolution, I decided early on that, over time, I’d learn more about what was going on than a fitter could learn in a static, time limited fit setting. My fitter confirmed that and provided valuable guidance on what to look for. I wasn’t changing what he did, but we both recognized some fine tuning was possible. This was not about me second guessing him. It took a long time to resolve, but along the way I recorded every attempt to address it. Eventually I had a record of what worked for me relative to saddle height, saddle pitch, saddle setback, saddle shape/construction/cushioning, kit padding, etc. The impact of some of these things was very subtle, but these issues were all part of the picture at some level. My most important discovery was that the issue commonly arose when my cockpit form fell apart (even just a little bit) with my pelvis tipping forward thus putting increased pressure on the perineal area. The onset of this condition could always be seen in locked out elbows which permitted the triceps and core to stop working, whereupon the back would become bowed in the lumbar region, rolling the pelvis forward, etc. (Form never fails on the fitter’s stand, but things change 3/4 of the way through a demanding 90 minute workout.) This could be brought on by fit issues and at times it was. While I could often improve things with subtle adjustments, I eventually saw there was no way I could “adjust” my way totally out of the issue. The last part of the equation was to “adjust me”. With conditioning coach guidance, I set to work on shoulders, triceps, and core, very specifically the TVA. (transverse abdominus muscle). I no longer have the issue while on the trainer. It will occasionally turn up while on the road on long climbs. When it does, its always about form collapse brought on by allowing triceps and/or core to take a time out. FWIW.
I was having some problems & switched to the Specialized Power Comp saddle. I really like this saddle for longer distances.
n=1, but here is what has helped me: I’ve had back problems in the past, so when I ride my bike, I rotate my pelvis forwards so that my spine stays more neutral. But that can result in more uncomfortable pressure on the saddle. I recently switched to the Specialized Sitero Expert Gel saddle, which has been great. I think it’s designed for time trials/triathlon, but I use it on my road bike. It has a large cutout through the whole saddle, so there’s nothing in the middle to put pressure on anything. I’ve also found that bibs with a flat, thinner chamois work well for me, because I think it concentrates more pressure on the bones of my pelvis, rather than the soft tissue.