This is a timely thread for me. I'm currently taking antibiotics for prostatitis due to perineal irritation from my saddle. I'm 72 now, btw. I've been riding a 2015 Specialized Allez purchased new. Before that was a 2013 Marin hybrid also purchased new. The Marin has become my wife's ride. Our daily rides are ~13 to ~23 miles.
I've had this issue before during the early years of riding this bike, and finally found some relief using a specialized power saddle with the large cutout. It was a tough saddle to 'fit' (especially the nose up/down), but I eventually got it right and spent the next 9 to 10K miles with no issues at all.
Fast forward to several months ago when I started developing shoulder issues. After some doctor ordered physical therapy, it was suggested that I try to take some weight off my arms and hands while riding, so I began adjusting the power saddle in an attempt to relieve any possible issues there. With those adjustment made, I'm now back to perineal pain and prostate infections.
The past 4 weeks have been a disaster both mentally and physically. I am frustrated to no end. After many 'test and tune' rides I have been unable to get anywhere near comfortable again.
I'm ether sliding down toward the bars, or I have the nose of the saddle digging into my perineal area and causing pain. I've been unable to find a happy medium.
I've adjusted (in small increments) saddle fore/aft, nose up/down, and saddle height. Lowering saddle height seemed to help some, at least compared to other adjustments.
I've always worn bike shorts. I wear both Sugoi and Pearl Izumi.
I've ridden 24K miles since 2012, about 15K of it on the Allez. I really enjoy my daily rides, but am losing faith that things will ever be like they were.
Thanks for listening/reading.