pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Puberty and Underwear: Boxers, Briefs or Commando?

September 22, 2018

[I have to tell you, this article about boy’s underwear in puberty has been an interesting one to write. Mostly because I usually write about documented recommendations with scientific support and this topic is pretty much a collection of known, assumed and extrapolated suggestions from information in areas sometimes only tangentially related. Therefore it still leaves a lot of room for personal preference]

I answered a question of a 16 year-old patient who had been the subject of some school-girls’ highly personal and intrusive questioning: “What kind of Underwear do you wear? boxers, briefs or commando?” He wrote into an answer-line: “Which is best?” and I told him I’d think about it and see if there was an informed answer that covered all the Tanner Stages.
Boxer shorts are usually the preferred Underwear by boys once the growth spurt of puberty is underway
This, I’m afraid, is the best take on the subject I’m able to pull together and uses a lot of the “research results” (if you can consider them that) surviving out of the couple thousands of years of living experience by the worlds population and cultures.

Yea, I know there is an article by a Urologist on the internet claiming “Just do what feels good”—and which hundreds of “me too” authors have parroted; BUT, the good doc is only living in the research world. The problem is that the results of fashion are NEVER EVER health tested before they are sold and THIS QUESTION is NOT yet answered in the research world.

For most in the so-called “western world” my answers may come a bit of a surprise; because, much of the “research” on the subject has come from the experience of the WHOLE globe and NOT the “fashion industry” which (I’m sorry to say) we seem to routinely lean on to do much of our thinking for us.

Boy’s Personal Hygiene
Underwear: Boxers, Briefs or Commando

So, what do we know about a boy’s body, safety and comfort that we can use to generate any kind of recommendations for what they should be wearing under their trousers, pajamas or nightshirts? Are there any differences between the various ages? Well, yes and no; and there are some things we know, but not a lot; and of what we do know and believe, not a lot has actually been scientifically studied and won a “top place.”

We’ll list the few things we DO know and eventually suggest some recommended usages for all three states; keeping in mind that the term “commando” as used here does not necessarily mean full “birthday suit.”

Boy’s Underwear History

We call it “personal” hygiene because it’s just that: personal – not the fodder for giggly girl games. Men’s underwear, like most things in a man’s life, isn’t discussed much because its only use is for functional purposes—as long as it works, who cares what it looks like… really.

So, looking at the shape and form of the “grass root product”—which the free use by the population has evolved over a very long time—is a legitimate place to start. Any bodily covering historically took a fair amount of effort to procure (think: hunt, kill, tan, harvest, card, spin, weave) so necessity ruled and frivolity had no place in the discussion.

While we sit a bit smugly here in the western world, we must remember that even today perhaps the majority of males in the world still use a simple wrap type of clothing and what would be considered “commando” under that. And do it without significant problems or health risk. [Even fools know better than to ask a Scotsman what he wears under his kilt, Arab under his thawb or Indian under his Dhoti.]

When weaving made underwear much more available, comfort began to be a consideration, but underwear design pretty much evolved over time, with experience, into the basic “shorts” pattern. Waist and legs a little higher; no, a little lower. Legs slanted; no, the other way and a little more firm. Remove that tie, use an elastic instead… oops, that one’s too tight.

That fabric is too scratchy, that one makes me sweat; but, nowhere could I find any scientific concern over what any of these pure preferences did to concerns like: fertility, cancer, ailments. Perhaps medically poor designs were taken into account through simple “natural selection” where people who made “stupid choices” were less fertile or in other ways taken out of the gene pool. After all I’m talking about “design by function” over hundreds and hundreds of years!

[However, I did find reference to a lawsuit in Australia over a man buying underwear that made him itch… and winning. And scientists in Scandinavia are burying underpants to test the fertility of the soil! Go Figure!]

Pure and simple: just give some protection to the sensitive skin in the groin area against the tough/rough leggings that were worn – and hold “things” still, while energetically moving around—you know, hunting, gathering and protecting.

At first, the manufacturing industry was also pretty pure intentioned; and initially, when automated looming became common, function and historical experience was still the driving force — WALLAH… men’s undercoverings were born (we call them “briefs” now).

However, when manufacturing became so good that excess capacity was created and looms were then sitting idle for much of the time, the ugly Pandora escaped from her box: the fashion industry.

“We need people to WANT more” was its mantra; so, janking around with style became commonplace (at least in western cultures.) The split front in boy’s underwear was a convenience that surprisingly took some “social engineering” to catch on, but finally did.

Then the invention of the zipper, and the fear that “things” could get caught in them, pretty much sealed the use of underpants in the male populations’ mind – for at least daytime use (in those cultures which used trousered zippers.)

Boxer’s came into vogue comparatively recently; but, pretty much EVERYTHING I’ve seen after that is sheer jank. And, in some cases, could even be detrimental.

Genital Injury

All children of course, not just boys, begin life with fairly specific requirements for protecting their environment from their lack of toilet training – a diaper of some sort. Daytime “dryness” occurs first, then nighttime.

Once a child’s development has reached the “dry” stage, hundreds of years of experience has taught that underwear is a good thing for many reasons, perhaps mostly for comfort but also for hygiene. Although, for boys, their “dangly bits” also demand a bit of additional consideration.

Many generation’s worth of lifetime-experiences have shown that, at least during the day when active, boys are better protected from their daily risks of activity by wearing underwear. [Again, especially since the invention and use of zippers] During the night there is no such need and may actually cause some untoward issues.

Admittedly less so than in times past, most boy’s activity level (hence injury-prone behavior) is higher than girls of the same age. Wearing briefs (which is probably the best for the age) does seem to protect from injury and disease in prepubescents.

As play turns to sports, the risk of injury is substantially greater and requires additional protection in the form of supporters and cups. Strangely enough, the fashion industry is NOT required to do any comparison studies to show that their so-called “sports briefs” are better or even equivalent to supporters, cups and other items which we know work. At best, they may be similar to supporters (but probably not) and in no way do they come close to being equivalent to cups. Teens should NOT count on them for protection during sports activities.

Then, with puberty, “body proportions” change so Underwear can opt to change to something less form-fitting; which, is also made possible due to the fact that adolescents tend to be less “all-over-the-place” active and concentrate their “play” to specific times when they can change into supporters and cups for protection.

Sterility

Perhaps it might surprise you to discover (or remember) that male testicles begin existence inside the fetus, way up in back under the kidneys. By some method we still don’t know, they begin their long journey down and through the abdomen to emerge out the inguinal ring where they force the development of the scrotum, their new home.

Why do they do all that? Only lately we’ve discovered that it’s to get out of the heat. Our internal body temperature is too high for testicles to develop sperm and testosterone effectively. And, how do we know that? Because, when they don’t make it all the way down and out, they then don’t produce adequate testosterone and often become cancerous.

Additionally, the body is developed with a “temperature control device” built into the scrotum: the dartos muscle (smooth muscle wrinkles skin to pull testes closer in when cold) and cremaster muscle (skeletal muscle that elevates [pulls away from body] the testes when hot).

These two muscles work together admirably to maintain the testicles at just the right temperature; that is UNLESS there is something binding them to the body (like so-called “sports briefs” and other elastic type underwear).

Just how much heat testicles can tolerate and for how long is NOT something that has been investigated scientifically to my knowledge. It appears that the weak elasticity of normal “briefs” probably does not disrupt normal temperature regulation—at least at the duration people have normally used them. Nor, obviously, do boxers.

The stretched compression spandex of so-called “sport’s briefs” worn 24/7 however, may be a different story, we just don’t know. They definitely increase both temperature and humidity; and even if it turns out that there’s little testosterone or sperm effect, there sure is a lot of yeast and other maladies being caused by them! Despite that, there’s lots of people with lots of very tightly-held opinions and very vocal arguments (even if they are wrong).

Just because there “seems” to be no gross statistical difference in fertility levels now is NOT evidence they are safe. There are tons of variables which haven’t been accounted for in such broad statements and it sure seems to me there are way more “low T” commercials than there used to be.

If we are sheerly empirical in our thinking, it stands to reason that the body deserves to have its ability to regulate its own testicles’ temperature intact for at least a portion of the day—like how it was made to do—without the avarice of the fashion industry disrupting the natural order for mere profit! This is perhaps the best rational for finding a place for “commando” some time in the day.

Sorry to say that the current generation of boys are the research subjects for testosterone levels, sterility and cancer caused by all the compression type underwear the fashion industry is manipulating them to buy (like ours was for the tobacco industry); but, again, no one is really keeping track… yet.

Spontaneous Erections

First-time parents and older siblings are often surprised to see male infants cycle through several erections each day. It has to do some with fullness of bladder but mostly because of the adult level of hormones in his bloodstream coming from his mother.

Once he is “evicted” however, those hormones diminish over a few months down to usual newborn levels and the spontaneous erections diminish—although not entirely, especially during sleep.

During puberty, hormones dramatically increase again (sometimes quite rapidly) leaving boys at jeopardy for spontaneous erections once more. Several times each night, for example, males have arousals in their sleep without knowing it. The stimulation of a full bladder can awaken a child or teen with an erection.

Although not common it’s not unusual to find adolescent patients, who have sleep difficulties arising from multiple awakenings per night, to be in the habit of wearing snug and or stretch underwear to bed. The explanation might be that the boy experiences discomfort from the normal cyclic arousals during the night, has disturbed sleep, then may awaken.

At least it’s my experience that IF a careful history is taken to discover the issue and the spandex-type underwear is removed, the awakenings usually subside.

Until the teen gets used to the adult level of hormones flowing through his body, it seems that his body no longer is under his own control; which is not only embarrassing but disconcerting as well. That is probably the leading cause of boys wanting (needing) to switch to wearing boxers beginning about twelve or thirteen. They have relievingly more leg room which is less binding.

Testicular Torsion, Meatitis

Nearly all children these days, even boys, seem to have an inordinate fear of meeting and conversing with new people (including doctors) let alone getting undressed. And, yes, all of us doctors understand that their idea of the best physical in the world can be done over the phone – even though terribly wrong.

However, it’s amazing just how many problems there are relating to “boy things” and just how many of them are “silent” until almost too late; and only picked up on a good physical. I’m not just talking about monitoring his “growing up” and physical development; I’m talking about bonafide illnesses and surgical issues.

Epididymitis, Meatitis, meatal stenosis, testicular torsion, hydrocele, spermatocele, occult hyper and hypospadias, yeast infections and trauma to name just a few.

None of these things boys like to talk about, especially to other people. Some of them they don’t even recognize as abnormal — until they become painful and then is almost too late. Some can be treated but a lot more difficult once they’ve spread deep into the tissues.

I’m not implying by reporting them here that they are for sure all related to types of underwear; but, all of these have been implicated by people with agenda’s on the internet in one way or the other.

What we do know is that irritation from too “tight” of underwear can trigger Meatitis; we see it happen many times in boys whose bodies outstrip their underwear sizes on the Christmas and birthday gift cycle. It can be easily treated (if recognized early) but (if not) often extends into strictures where surgery is the treatment.

We also know that vigorous exercise and sports without proper testicular support can lead to epididymitis, perhaps torsion and other issues. And we know that improper hygiene can lead to infections of all sorts.

What Underwear Are Boys Using Now?

It’s obvious that what boys are using now for sleepwear prior to puberty is: whatever their mom’s or dad’s have been dressing them in at night since they left their diaper behind.

On most of the planet except the western world it’s nearly always the ethnic, loose-fitting nightwear and (what I’m referring to as) so-called ‘commando’ under that.

In the western world, If the “dresser” is mom then it’s more likely to be the full-monty pajama tops and bottoms (or footed onesie) over undershirt and briefs—usually sporting some cartoon character or the other.

If the “dresser” is dad, it’s more likely to be ‘commando’ under nightshirt, onesie, pajama bottoms or loose-fitting boxers (not boxer briefs or trunks) than if mom did it; but, the fashion industry has its tentacles into us too and pajamas over character briefs are quite pervasive.

As boys get older and begin finding their voice, preferences are taken into consideration—often without much thought. So-called “sports briefs” have become a rage of sorts and are the culprit of much sleeplessness [and who knows what else as time progresses].

Older still, it has to be said, the avarice of the fashion industry has created quite a market for sex within underwear. Further still into maturity and college, a form of practicality and comfort returns in the form of nightshirts and loose-fitting ordinary boxer-shorts during sleep.

What’s The Verdict On Which Underwear To Use?

So, with all this hedging-of-bets and disclaimers due to lack of actual scientific studies, what should we do?

I’m sure you realize that this topic isn’t high on a pediatrician’s list of “well child care” advice; although, perhaps it should be. However, the question was asked of me. It was a legitimate question in the context of a child’s life and I promised to take a crack at answering it—even though there isn’t a lot of hard-and-fast-evidence.

So, here’s the way I would advise a parent or patient about the subject if they asked me for an informed opinion:

• Use a diaper until the child is continent, especially at night.
• When toilet-trained in the day, regular, old-fashioned briefs should be worn during the day—especially if trousers contain zippers; while diapers are still used at night.
• Much of ethnic tradition can be followed while merely keeping aware of the several issues described below.
• When continent during the night, the younger child is probably OK at night in briefs that are not tight fitting; however, going “commando” under a nightshirt or loose-fitting pajama bottoms is probably a good habit to teach for intuitive reasons, preparing for changes that will occur during puberty.
• During and after puberty, sleeping “commando” under a nightshirt or loose fitting pajama bottoms or in “regular, old-fashion” boxers (see graphic above) makes intuitive sense and is practical
• Sports briefs or compression-type underwear of any kind are for use during activity and sports; but, DO NOT substitute for either athletic supporters or cups NOR should they be worn continuously or through the day and night.
• In any culture that wears trousers with zippers, underwear (of some kind) MUST be worn under the pants without fail, in order to protect against entrapment.
• Underwear should be changed and laundered when even lightly soiled. In childhood this amounts pretty much to every day.
• Attention should be paid by parents to the boys growth in order to avoid wearing those which are too tight. “Grown-out-of” underwear should be discarded (to avoid the child wearing them “in a pinch”). And it is probably unwise to hand-down underwear to the “next younger child in line.”

Does that help? Hope so.