Who are the Ideal Candidates for Scrotoplasty & How is the Scrotoplasty Procedure Done?

Scrotoplasty is a surgical procedure done to repair or treat existing scrotum or for creating a new scrotum.

Scrotoplasty is mostly performed in infants with birth defects that affect the scrotum and its functioning but may also be done on adults. Scrotoplasty is done for:

• Gender affirmation
• Cosmetic reasons
• Injury or congenital defects

It is important to be aware of the risk and complications associated with scrotoplasty, especially if you are going ahead with it because of cosmetic reasons.

The scrotum is a sac located below the penis. The main role of the scrotum is to protect the testicles.

It protects the testicular implants in those who have had gender affirmations surgery.

It makes the testicles hang away from the body and keep the temperature lower than the rest of the body i.e. around 93.2°F, a temperature ideal for sperm production. The shape and skin texture of the scrotum changes in response to various stimuli. It relaxes when the body is warmer. During sexual stimulation, cold temperatures, or exercise, it moves closer to the body.

Scrotoplasty is recommended to people in the following conditions

• As a person gets older, the muscle tone of the scrotum weakens. It sags and can get lower than it did earlier in life.
• An older man with low-hanging scrota can be a good candidate for scrotoplasty. Here it is known as scrotal lift surgery.

• Individuals with enlarged scrotal sac would be uncomfortable during sexual activity, sports, and exercise.
• Scrotoplasty can reduce the size and sag of the scrotum and lessen the discomfort.

Penoscrotal webbing is a condition in which the skin connecting the penis with the scrotum extends along the underside of the penis shaft like a web. It is not a serious medical condition. The condition affects the self-esteem of individuals.⁽¹⁾

Scrotoplasty is recommended in such cases.

• In buried penis, the penis of the young infant is attached to his scrotum with an excess of skin.
• During scrotoplasty, the extra skin is cut off and the scrotum is reshaped.

Candidates seeking gender affirmation surgery for female-to-male transitions are also good candidates for scrotoplasty.

In this condition, the surgeons do not reshape an existing scrotum but recreate it from the existing tissues.

According to the American Society of Plastic Surgeon, an ideal candidate for female-to-male transition is the one who has been:⁽²⁾

• Diagnosed with gender dysphoria
• Living as a member of the desired sexual identity
• An individual whose decision is supported by two mental health professional

• Some individuals go ahead with scrotoplasty for cosmetic reasons. Such individuals want their scrotum to look in a certain way their partner, finds it attractive.
• There has been relatively less research to look at the effectiveness of scrotoplasty for the aesthetic purpose.⁽³⁾

Before going ahead with the procedure make sure of the below-mentioned pointers.

• Arrange for someone who can drive you back home, as being under anesthesia, driving would not be possible and would be unsafe as well.
• Inform the doctor if taking any medication, as you might have to stop them a day or two before the procedure. For example aspirin can cause a risk of bleeding.
• Be informed about when to stop eating and drinking before the procedure
• Make sure you shower before the procedure and avoid applying any moisturizer or other skincare products

The steps involved during the procedure are as follows.

The steps involved in this type of scrotoplasty depend on the reconstruction required.

The procedure includes the following steps:

• Local anesthesia is given near the scrotum to numb the area. If tightening of cremaster muscle is needed twilight anesthesia is also given. It pulls the scrotum up when the scrotum contracts.
• A small incision is given at the base of the penis to remove a small amount of skin.
• A skin graft is taken from elsewhere on the body if the scrotum has been stretched and needs reinforcement.
• On completion of the surgery, the incision is closed.

Female-to-male transition scrotoplasty is often performed with other procedures including:

• Metoidioplasty, in which existing genital tissue is taken to create a new penis.
• Phalloplasty, in which skin from elsewhere on the body is taken to construct a penis.
• The patient is given general anesthesia and an incision is made in the lower part of labia majora and around the pubic bone.
• To create a sac, the flaps are turned upward. Dissolvable sutures are used to attach the flaps in the shape of a scrotum.

The results vary according to the purpose of scrotoplasty.

A scrotal lift is done to make the scrotum appear less saggy. Due to gravitational pull the weakening of the tissue and muscles, a follow-up procedure is needed at some point.

After the FTM transition, it takes some time for someone to get used to having a scrotum.

A study found in the labia majora flab method the presence of minor wounds was common but was treatable.⁽⁴⁾ Hematomas were rare.

Just like with any type of surgery bleeding and infection are complications.

Other risks include:

• Nerve injury
• Scarring
• Injury to the urinary tract
• Painful intercourse
• Failure of the transplanted skin or tissue to survive
• When complications arise, corrective surgery might be required.

The too large or too saggy scrotum can be uncomfortable. To go ahead with scrotoplasty, it is important to look for a surgeon with good experience with the type of scrotoplasty needed.