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| |    Disposable Diapers and Scrotal Temperature by Robert Needlman, M.D., F.A.A.P. The study, "Scrotal temperature is increased in disposable plastic lined nappies" was written by C-G Partsch, M Aukamp, and W G Sippell of the Division of Pediatric Endocrinology at the University of Kiel, Germany. It was published in the October issue of Archives of Disease in Childhood, Volume 83, pages 364-368. You can read the abstract of the article at Article Abstract, or download the full article from the publisher for a fee of $8. The Rationale for the Study Over the last 50 years, the average sperm counts in adults have fallen by as much as 50%, and testicular cancer is on the rise. Plastic-lined, disposable diapers have been popular over the same time period. The male scrotum is designed to keep the testicles cool, compared to the rest of the body. Since this is the case with all mammals, sperm production seems to require cooler temperatures. If plastic-lined diapers raise testicular temperature, could they play a role in the increase in testicular problems? Background information There are many studies that have a bearing on this question. In adults, increased testicular temperature -- for example, while in the sauna -- appears to decrease sperm count. (Sometime back, there was a well-publicized concern that tight-fitting briefs might lower sperm counts, but at least one study showed no difference in sperm counts comparing briefs and boxers.) There are no studies showing the same thing in children. Study Plan The researchers recruited 48 healthy boys to participate in the study. Their ages ranged from 0 to 55 months. Each boy wore a sensitive temperature probe taped to his testicles for two 24-hour periods, one period with cloth diapers, the other with plastic-coated disposables. The probe recorded the scrotal temperature twice a minute. The boys also had rectal temperatures measured, and their mothers filled out an activity log, including the number of diaper changes. In any medical research, it's important to consider whether the research is ethical. The boys had no say in choosing to participate (their moms made the decision), but they were not hurt in any way and there was no risk of harm to them. The study was deemed ethical by the Ethics Committee of the university. What They Found For each boy, the researchers compared the average scrotal temperature when he wore plastic-covered diapers versus cloth diapers. On average, the in-plastic temperatures were approximately 1 degree Celsius (1.8 degrees Fahrenheit) higher than the in-cloth, with the biggest differences found in the youngest babies. This difference could not be accounted for by less frequent diaper changes while wearing disposables. They also looked at the maximal scrotal temperature -- the highest temperature recorded in 24 hours. As a group, while wearing disposable diapers, the boys experienced maximal scrotal temperatures of 37.0 to 37.4 degrees C, with 37.0 being the normal internal (rectal) body temperature. The normal difference between rectal and scrotal temperatures (with rectal higher) was not observed in 13 of the 48 boys while wearing diapers. What It Means This study does a good job of showing that scrotal temperatures were higher while wearing plastic-coated diapers in this group of boys. It raises the question of the effect of raised testicle temperatures, but it leaves the answering of that crucial question to future studies. In the meantime, there are some practical questions that the researchers did not answer: (1) What brand of diapers (both disposable and cloth) were used? Does that make a difference? (I'd guess that there are differences in the thickness of the paper liner and the plastic, as well as in the tightness of the leg bands, that might make a difference in the diaper's insulating properties). Also, the study was done in Germany -- do they have the same brands there as here? (2) How tightly were the diapers put on? If the moms in the study were used to disposables, my guess is that they didn't put the cloth ones on very tightly. It took me a long time to get my cloth-diaper pinning technique down! Would tighter cloth diapers have acted more like the plastic-lined ones? (3) Did the babies wearing cloth also wear plastic diaper liners? Probably not, or the researchers should have said so. But it's common practice for parents here to put plastic pants over the diapers. (4) Were the parents who participated aware of the study's hypothesis? Sometimes the expectation that a certain outcome will occur can lead to subtle changes in what people do. (In this case, for example, did the parents in the cloth group let the babies air out for longer with each diaper change? We can't tell from the study.) How Concerned Should You Be? This is a hard question to answer, because it depends a lot on your personal approach to risks. While it's possible that using plastic diapers might cause decreased sperm counts or other problems years later, it is far from proven. Here are some possible courses of action to consider: (1) Keep on using disposables. The data are not in yet. Disposables may offer some advantages that are important to you, and outweigh the theoretical risk raised by the study. (2) Switch to cloth. They might be more comfortable for your baby (if you change them frequently), and we now know that they are probably cooler. (3) Substitute cloth for plastic some of the time. This might make especially good sense when your child has a fever, since that is when scrotal temperature is likely to climb. (4) Let your boy go diaper free for periods of time each day. I'm convinced that this air time, so to speak, helps reduce diaper rash, and boys seem to like it. Keep some paper towels handy! Date created 9-29-00
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