Low Hanging Balls: Not Simply a Cosmetic Problem
“Why do I have old-man sagging balls?” is a question I am asked frequently, even by young men. A scrotum that hangs low can be a source of worry and embarrassment and even keep one from participating in sports or just enjoying a day at the beach. Many men regard low hanging balls as simply a cosmetic issue and seek help from a plastic surgeon. In reality, the sagging scrotum is usually caused by a medical problem called a varicocele.
Causes of “Saggy Testicles”
You may wrongly attribute a low-hanging scrotum to the aging process. After all, everything sags as we grow older, right? The prankster Johnny Knoxville has made this painfully clear with his prosthetic “old man balls” antics. Certainly, he has a point, although exaggerated. Your scrotum can droop with age, but the problem is likely due to a varicocele.
A varicocele is a swelling of the veins surrounding the testicles. This phenomenon is due to a backflow of blood that causes the blood vessels to engorge. Although some varicoceles produce no obvious symptoms, the condition has a few classic signs. Among these indicators are low-hanging testicles and asymmetric testicles, where one side – usually the left – droops lower than the other.
Your testicles need to be a few degrees cooler than normal body temperature which is why they are located outside your body. But if you have a varicocele, warm blood from your abdomen can pool in your scrotum, raising the temperature. This rise in temperature is why men with varicoceles often have low-hanging scrotal sacs. As the temperature grows, your testicles move farther away from your body to seek a cooler environment, causing an elongated scrotum.
Another classic symptom of a varicocele is a feeling like “a bag of worms.” Patients may have a sensation of shifting inside their scrotum. Many varicocele patients also report pain associated with their condition.
As well, varicoceles are strongly associated with male infertility and low testosterone levels. The numbers make this fact obvious: Around 17 to 21 percent of all male infertility cases are due to varicocele. This makes varicocele the single most common cause of fertility issues in men.
Treating Low Hanging Balls
Cosmetic surgical procedures aren’t just for Hollywood stars anymore. New techniques and novel treatments have caused a renewed interest in cosmetic surgery. Among these newer offerings is a procedure called a scrotoplasty, more commonly known as a ball tuck or scrotal lift. The surgery is similar to a facelift – but for your boys. The surgeon trims away excess skin which lifts your scrotum and can even reduce wrinkles, turning your prunes into plums.
Sounds great, but the problem is that if your low-hanging scrotum is usually caused by a varicocele, a scrotoplasty will do absolutely nothing to resolve the underlying condition. In fact, a scrotoplasty may be harmful to your testicles, because it will expose the testicles to excessive heat.
Treating a Varicocele
Just as the increased temperature caused by a varicocele can cause your scrotum to hang, repairing the varicocele will lower the temperature and allow your scrotum to contract – without a ball tuck. A microsurgical procedure called a varicocelectomy is the definitive treatment for varicoceles. I’ve performed over a thousand microsurgical varicocelectomies and can tell you that I have never cut the scrotum during the procedure. Microsurgical varicocelectomy is also less painful than a scrotoplasty.
I make an incision about an inch long between the groin and navel, find the offending veins and tie them off. This reduction in blood pooling corrects the reflux problem and permits the swelling to go down. The scrotum gradually returns to its natural position, which may also improve fertility and testosterone levels, solving both the cosmetic issue and medical problem with a single procedure.
If you have any testicular symptoms, or are contemplating Varicocele surgery in New York, please contact Dr. Fisch at 212-879-0800 or