What’s the Best Underwear to Boost Fertility? Would Men be Healthier Going Commando? Here’s What Scientists Found.

The Y-front is now 80 years old, but is still a stalwart of the male wardrobe, with more than 500,000 pairs thought to have been given as Christmas presents recently.

But the type of underwear you choose could be more than just a fashion or cultural statement. Experts now believe it can affect health, too.

From allergies to fertility and pain, here the specialists reveal why men’s choice of underwear deserves some careful consideration…


Anywhere where the skin creases is prone to a form of dermatitis known as intertrigo, which leaves skin red and sore. In men, this is more common in the groin – it’s known colloquially as ‘jock itch’ – and is exacerbated by the material in their underwear, says Adam Friedmann, a consultant dermatologist at the Whittington Hospital and the Harley Street Dermatology Clinic, in London.

‘Intertrigo is usually caused by a combination of eczema, a slight fungal infection (fungi particularly like warm, moist areas) and an irritant such as sweat – so men who exercise a lot may be prone to it, as too are men generally in the summer.

‘To prevent it or reduce its symptoms we always recommend men wear pants made from absorbent materials such as cotton which will soak up sweat and wick it away from the skin.’

Less absorbent materials, such as silk, nylon and Lycra, can make the problem worse, especially if you choose tight, body sculpting pants made with these materials, as they keep the testicles close to the body, adds Christopher Eden, professor of urology at the Royal Surrey County Hospital, Guildford.

Because testicles are generally warm and sweaty, they can be a hotbed for fungi as they provide a warm, moist environment.

‘You want that part of the anatomy to dry out easily and breathe,’ says Professor Eden.

Dermatologists recommend men wear pants made from absorbent materials such as cotton


Men can experience passing aches and pains in their testicles, though it’s not known exactly why this happens. Indeed Professor Eden describes it as a ‘significant enigma in urology’ which usually disappears just as mysteriously. The problem generally affects men aged 20 to 40.

‘Some men experience this regularly, while for others it occurs after ejaculation, or after sitting for a long time while driving, for example,’ explains Zaki Almallah, a consultant urologist at Queen Elizabeth Hospital and BMI The Priory Hospital, Birmingham.

Wearing tighter underwear may help – although this will be down to the individual, he adds.

‘With looser-fitting underpants the testes are less compressed, so in principle this should be less painful, but some men find that tighter underwear is preferable because it reduces movement, and therefore the impact on the testes – it is a matter of trial and error.’

Men who’ve undergone any type of testicular surgery, such as a vasectomy, are advised to wear snug-fitting pants in the days afterwards to prevent bruising or a hematoma (localised collection of blood), and to help with pain, explains Mr Almallah. The pants have a compression effect, inhibiting swelling and bleeding.

It would be best for men with fertility issues to avoid tight pants and choose something looser, such as boxers, to keep the testes cool

However, men who have epididymitis – inflammation of the epydidimis, the coiled tube at the back of the testicle that stores sperm – can find wearing tight underwear is painful as it can squash the area.

‘The condition is generally associated with sexually transmitted infections and urinary infections – men who have inflammation in their testes should see their GP for treatment, but wearing looser pants could be more comfortable,’ says Mr Almallah. Young men with sudden, severe testicular pain should seek emergency medical attention to exclude testicular torsion, when the cord that supplies the testicles with blood becomes twisted.


Men who suffer from allergies such as eczema often develop a ‘contact’ rash if their pants have elastic in the waistband, says Dr Friedmann. Blame it on the rubber in the elastic, which many people are allergic to.

‘If there is rubber in the waistband and you sweat, then tiny bits of rubber sweat off onto the skin around the waist which can trigger a reaction,’ he explains.

The colour of your underwear could, toocause problems, too. The compound PPD, which is used as black dye in poor quality, cheap pants, can cause a contact allergy, says Dr Friedmann. So stick to reputable brands.

Men can experience passing aches and pains in their testicles, though it’s not known exactly why


Sperm is produced in the testicles which need a slightly lower temperature than the rest of the body to work efficiently, says Mr Almallah. They need to be about 35c, around two or three degrees lower than body temperature – Nature’s way of keeping them cool is to keep them hanging outside the body.

If it’s too cold outside, the dartos muscles in the wall of the testicles contract, pulling them towards the body to raise their temperature.

‘Wearing tight underwear effectively always brings the testes close to the body, and takes away the natural mechanisms which regulate their temperature,’ adds Mr Almallah.

‘In theory it would be best for men with fertility issues to avoid tight pants and choose something looser, such as boxers, to keep the testes cool.’

In a study published in 2012, Allan Pacey, professor of andrology (the study of male reproduction) at the University of Sheffield, found that men who wore tight-fitting pants had a lower concentration of moving sperm compared with those who wore boxers.

‘This suggests that changing to looser pants may be a low-cost way of helping fertility,’ says Professor Pacey.

And steer clear of polyester.In a unique study in 1993, Professor Ahmed Shafik, a researcher in human sexual physiology, found that dogs made to wear polyester pants for two years had a significant reduction in sperm count and moving sperm, and a rise in damaged sperm.

All these changes were reversed in most of the animals after the polyester garments were removed. Dogs that wore cotton pants, and those that had no pants, showed no significant changes to their sperm. Professor Shafik then did human studies in 1999, with the results mirroring the animal study: four out of 11 men wearing polyester pants experienced a reduced sperm count and testicular changes after 14 months, which were reversed six months after they stopped wearing them.

The group wearing cotton pants had no adverse effects.

‘I think this is to do with the fact polyester is a better insulator than cotton, so it will keep the testes slightly warmer,’ says Professor Eden. ‘And because polyester has more of an elastic property it may pull the testes nearer to the body, which again warms the area.’


Men with varicoceles, a form of varicose veins in the scrotum, may want to think carefully about their pants. Varicoceles – which affect 15 per cent of men – can be symptomless but may cause a dull ache.

They are caused by the failure of the valves inside the vein, which causes the blood to pool, stretching the walls and enlarging it.

Studies have linked varicoceles to reduced fertility – one study from the World Health Organisation involving more than 9,000 men showed that varicoceles are commonly accompanied by impaired sperm quality.

‘There are theories that having varicoceles means there is more blood than normal around the testes, making them warmer, so this could affect sperm production and fertility,’ explains Mr Almallah.

Animal and human studies have also linked varicoceles with reduced testosterone levels – the extra warmth may interfere with the cells that produce testosterone, which are sensitive to temperature.

Reduced testosterone can cause erectile dysfunction and low libido; low testosterone has also been linked with a higher risk of metabolic syndrome, a combination of diabetes, high blood pressure and obesity.

‘It would be logical for men with varicoceles not to wear tight underwear not only to protect their fertility, but possibly their long-term health,’ says Mr Almallah.

However, men with varicoceles that cause pain can find snug pants helpful, adds Professor Pacey.

‘If they wear boxers and their testicles are hanging down and get knocked, that causes pain and local inflammation. Support from tighter pants reduces that risk. Yet, wearing tighter pants is a double whammy for their fertility risk.’


Boxers don’t offer much support, but if you aren’t experiencing testicular pain such as from varicoceles, that doesn’t really matter, says Professor Eden. ‘Men don’t actually need firm scrotal support for their health. After all, clothes are a relatively modern invention.’

Tight-fitting pants won’t stop the sagging linked to ageing, either. ‘As we age, the elastin [the stretchy component of skin] decreases, causing wrinkles and saggy skin, and this applies to the scrotum too,’ explains Professor Eden. ‘But supportive underwear won’t change that.’

When it comes to sport, support may be down partly to keeping things under control.

A spokesman from British Athletics says distance runners tend to prefer wearing ‘split shorts’ – shorts with a netted lining, similar to swimming trunks – with no pants underneath, because this gives support and allows the area to breathe, with the comfort of wearing only one garment.


Arguably men would be best off wearing no underwear, says Professor Eden. ‘This would reduce sweating, reduce their chance of getting skin infections and could improve fertility. In Indonesia men wear sarongs and Scottish men wear kilts and from the point of view of testicular health, they’re doing the best thing they can do.

‘But men want some degree of support for the sake of comfort and from a hygiene perspective they don’t want that part of the anatomy in contact with their trousers which can be more expensive to clean, so most prefer wearing pants.’

If going commando isn’t for you, Professor Eden recommends ditching pants at night. ‘Sleeping naked allows the area to breathe and the testes to remain cool, helping fertility.’

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