A scrotum that hangs loose is, for most men, a sign that it’s working as designed. Its whole job is to keep the testicles a little cooler than the rest of the body, and slack skin is one of the ways it does that. Its looseness also isn’t fixed: the same scrotum can look tight one minute and saggy the next. Looseness that comes with new swelling or a lump is a different matter, and worth having checked.
How Your Scrotum Tightens and Relaxes
Sperm develop best a few degrees below core body temperature, which is why the testicles sit outside the body. Two separate muscles control how high they sit. The first is a thin layer of muscle in the scrotal skin itself. It tightens and wrinkles the skin or lets it go slack.1PubMed. Dartos reflex: a sympathetically mediated scrotal reflex The second wraps around the cord and the testicle and pulls the testicle closer to the body when it needs warming.2Pabau. Cremasteric reflex: How to elicit it and what absence means Different nerves run the two, and the one in the skin works automatically, without any conscious effort.3PubMed. Dartos reflex: a sympathetically mediated scrotal reflex
When it’s cold, the scrotal muscles contract, tightening the skin and drawing the testicles up for warmth.4The Conversation. Summer long balls? A health expert explains why hot weather can be tough on testicles In heat it relaxes, and the scrotum hangs lower so the testicles can cool off.5The Conversation. Summer long balls? A health expert explains why hot weather can be tough on testicles
After a hot shower or bath, the scrotum often looks long, smooth and heavy. In a cold pool or on a cold morning, it shrinks into a tight, wrinkled pouch, and the change can happen within minutes.
The wrinkles have a purpose. When the muscle in the scrotal skin contracts, it bunches the skin into folds, which cuts the surface area that loses heat. When it relaxes, the skin spreads out and releases more heat.
Because the two muscles do different jobs, a scrotum can look loose and smooth while a testicle is still pulled up close to the body. The muscle around the cord works on each side independently, which is also why one testicle often sits higher than the other at a given moment.
Most men also have one testicle that hangs lower, often the left, though this varies. The difference in height is thought to keep the two from pressing against each other when you walk or sit. A mild difference you’ve always had is ordinary. A new change in one side’s size or position is the part worth noticing.
Other Everyday Reasons It Moves Up or Down
During sexual arousal, the testicles usually move up toward the body as the muscles contract.6Sexologists in Chennai treating Men’s Infertility. What happens to a man after sex? Afterward the muscles relax and the testicles slowly settle back down into the scrotum.7Sexologists in Chennai treating Men’s Infertility. What happens to a man after sex? The body’s stress and exercise response can also make both muscles contract, lifting the scrotum, for example at the start of a run.
Once the activity ends, the muscles relax while blood flow is still up, so the scrotum may hang lower than before. This lasts minutes to hours and settles by itself.
Fear, a cold touch, or a stroke of the inner thigh can make a testicle jerk upward. That’s a normal reflex of the muscle around the cord, and it shows the muscles are working even if the skin looks loose most of the time. With a strong reflex, a testicle can ride up near the groin. It usually drops back down once you relax or warm up. A testicle that stays up and is painful should be seen urgently.
A normal change in looseness comes and goes within hours and follows what you’ve been doing, such as exercise, sex or a warm bath. A change that stays put for days or weeks, or that comes with a lump, swelling or pain, doesn’t fit that pattern and is worth checking.
Why It Gets Looser With Age
The body makes less collagen with age, so skin everywhere becomes less elastic.8GetMeGiddy. Why Do My Balls Hang So Low? The muscle around the cord also weakens over time, like other muscles in the body.9GetMeGiddy. Why Do My Balls Hang So Low? The scrotum therefore tends to hang lower and spring back less as the decades pass.
Men usually notice the change after years rather than weeks. The skin may also look thinner and more wrinkled at rest, the way skin on the backs of the hands changes.
Age-related looseness comes on gradually over years and affects both sides evenly. The testicles themselves feel the same size and texture, and there’s no pain, lump, or heaviness on one side. A sudden change over a few months is a different pattern and should be checked.
Some men have naturally loose scrotal skin from their teens onward, so looseness isn’t only an age issue. Large changes in body weight can change how the skin and the tissue around the groin look, though that isn’t specific to the scrotum.
Loose skin in itself doesn’t mean lower fertility, because fertility depends on the testicles, not on how much skin surrounds them. Erections and sex drive aren’t affected by scrotal looseness either.
Medical Conditions That Can Stretch the Scrotum
A varicocele is a set of swollen veins in the scrotum. It usually forms on the left side and often causes no symptoms.10Mayo Clinic. Varicocele – Symptoms and causes When it does, it causes a dull ache that’s worse standing or late in the day and eases lying down.11Mayo Clinic. Varicocele – Symptoms and causes A large one can feel like a “bag of worms” above the testicle.12Mayo Clinic. Varicocele – Symptoms and causes The extra blood it holds can stretch the skin and add to sagging.13Sébastien Beley Urologie Paris. Scrotal lift: treating scrotal laxity
A hydrocele is fluid collecting around the testicle, which makes the scrotum bigger and heavier.14Sébastien Beley Urologie Paris. Scrotal lift: treating scrotal laxity Left for a long time, it can stretch the scrotal skin permanently.15Sébastien Beley Urologie Paris. Scrotal lift: treating scrotal laxity A cyst on the tube behind the testicle can stretch the skin in the same way.16Dr Mischel Neill. Scrotal Surgery Procedures A hernia pushing into the scrotum can leave the skin loose even after it’s repaired.17Sébastien Beley Urologie Paris. Scrotal lift: treating scrotal laxity After a large hydrocele or cyst is removed, the scrotum usually shrinks back within 2 to 4 weeks.18Dr Mischel Neill. Scrotal Surgery Procedures
A varicocele and a hydrocele are easy to mix up. Swollen veins tend to feel soft and lumpy, like a bundle of cords, and sit mostly on the left. Fluid around the testicle tends to feel smooth and fluid-filled, and it is usually painless. A doctor can often tell them apart by shining a light through the scrotum, since fluid lets light pass.
A hernia is different. Part of the intestine or belly tissue pushes through a weak spot in the lower abdominal wall and can travel down into the scrotum. It often shows as a bulge that grows when you stand, strain or cough and may shrink when you lie down. Unlike fluid, it can sometimes be pushed back up, but it shouldn’t be forced, and any hernia that’s painful, hard or won’t go back needs urgent attention.
You can check yourself by feeling the scrotum gently in a warm shower, when the skin is relaxed. A normal testicle feels smooth and firm, with a soft tube behind it. A swelling that’s bigger when you stand or cough suggests veins or a hernia. One side that’s suddenly larger, or a firm lump on a testicle, needs a doctor.
Sudden severe pain in a testicle is an emergency, so go straight to an emergency room. A painless hard lump on the testicle should be seen within days or weeks. A dull ache or a heavy feeling on one side is worth a routine appointment.
The doctor will usually examine you standing and lying down, since some swellings change with position. An ultrasound is painless and shows whether the swelling is veins, fluid, a cyst or a hernia. Many of these conditions need no treatment if they aren’t bothering you, and treatment is considered when there is pain, a large size or other concerns.
Does Underwear Make a Difference
Boxers and briefs left the scrotum at almost the same temperature, about 34 °C, in one comparison.19PubMed. Are boxer shorts really better? A critical analysis of the role of underwear type in male subfertility Tight-fitting underwear can raise scrotal temperature by about 1 °C.20PubMed Central. Garment fit, scrotal thermoregulation, and male fertility outcomes: a narrative review So snug underwear lifts and supports, but very tight styles warm things slightly.
For a loose scrotum, briefs or trunks with a supportive pouch keep things from swinging during walking and sports. Moisture-wicking fabric cuts sweat and chafing in hot weather. Firm support doesn’t need to be tight enough to squeeze.
Underwear doesn’t alter the muscle or skin underneath, but a supportive pair can make a loose scrotum feel more comfortable. Going without doesn’t make the skin looser either.
Good support holds things in place without pressing in, so you shouldn’t feel pinching, pulling or marks on your skin at the end of the day. If you feel hot or sweaty in the groin, or notice red marks at the leg openings, the fit is likely too snug. Try a size up or a different cut.
Rubbing against the thigh can cause redness and itching. Irritation of scrotal skin is common and is often mistaken for a fungal infection. Keeping the area dry and avoiding harsh soaps usually helps.
What You Can Do If It Bothers You
Many men have no symptoms, but some feel embarrassed in shorts or swimwear.21Cureus. Scrotal Rejuvenation Others get discomfort from rubbing against the thigh, or pain during sex or sports.22Cureus. Scrotal Rejuvenation Some surgeons use a scrotum hanging more than 1 to 2 cm below the tip of the penis as one rough guide, though how much it bothers you matters more.23PubMed. Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults
Supportive underwear and keeping the skin dry deal with much of the rubbing and discomfort for many men. If a swelling such as a hydrocele is the cause, treating that comes first, because the skin often shrinks back afterward. Surgery for the skin alone is generally something to consider once simpler measures haven’t been enough.
A procedure called scrotoplasty removes extra scrotal skin, and it can also correct webbing between the penis and scrotum.24PubMed. Reconstructive surgery of the scrotum: a systematic review These operations are described as fairly easy, safe and effective, though there’s limited research behind them.25PubMed. Reconstructive surgery of the scrotum: a systematic review It’s usually a short outpatient operation under anesthesia. Expect swelling and soreness for a couple of weeks. The surgery doesn’t stop aging, so some looseness can return over the years.
A family doctor can check for swelling first, then refer you to a urologist. Describe when it bothers you: walking, sports, sex, or appearance.
If you see a surgeon, ask how many of these operations they’ve done, since the research is limited and experience matters. Ask what scarring to expect and where it will be, since scrotal skin often heals with a fine line that can be hidden in natural folds. Ask also how it might affect sensation, and how long you should avoid exercise and sex afterward, since returning too early can cause bleeding or swelling.