ARE BOXER SHORTS REALLY BETTER - A CRITICAL ANALYSIS OF THE ROLE OF UNDERWEAR TYPE IN MALE SUBFERTILITY

Purpose: Elevation of testicular temperature may result in arrest of s permatogenesis, abnormal semen parameters and sterility. It has been p roposed that brief style underwear may produce scrotal hyperthermia an d lead to clinical subfertility. Although this idea is regarded as dog ma by many in the lay community and the changing of underwear type is a therapy frequently recommended by medical practitioners, there is a paucity of data measuring scrotal temperature as a function of underwe ar type. Materials and Methods: Scrotal, core and skin temperatures we re measured in 97 consecutive men presenting for evaluation of primary clinical subfertility. These cases were categorized by underwear type to boxer or brief group. Semen analyses were obtained in all patients . Individuals from each group were compared to ascertain differences i n temperature when wearing and not wearing underwear. Baseline semen p arameters also were compared. In 14 subjects (crossover group) underwe ar type was changed to the alternative type and scrotal temperature me asurements were repeated. Literature regarding underwear type, testicu lar temperature and/or fertility was reviewed and critically analyzed. Results: Mean scrotal temperature plus or minus standard deviation wa s 33.8 +/- 0.8C and 33.6 +/- 1.1C in the boxer and brief group, respec tively. There were no significant temperature differences between the groups. Differential temperatures comparing core to scrotal temperatur e and semen parameters also were not significantly different. These ob servations remained constant in the crossover group. Conclusions: The hyperthermic effect of brief style underwear has been exaggerated. In our study there was no difference in scrotal temperature depending on underwear type. It is unlikely that underwear type has a significant e ffect on male fertility. Routinely advising infertility patients to we ar boxer shorts cannot be supported by available scientific evidence.