Scrotoplasty

Overview

Scrotoplasty is a surgical procedure aimed at addressing issues with the scrotum, such as a buried penis or a webbed penis. It is also used to create a new scrotum during gender affirmation surgery. The scrotum is a pouch located below the penis that encloses and protects the testicles.

Reasons for undergoing the procedure

There are various reasons why both children and adults might undergo scrotoplasty. Some individuals are born with congenital conditions affecting their scrotum, while others may develop issues later in life. Additionally, some people choose scrotoplasty for personal or gender affirmation purposes.

• Buried penis: This condition can affect both children and adults. In children, it is a congenital issue where the penis may seem hidden by the surrounding skin of the scrotum, thigh, or abdomen. This can be present from birth or result from prior procedures like circumcision that either removed too much or too little foreskin.

In adults, buried penis often arises due to obesity, where excess abdominal fat can obscure the penis, or from conditions like lymphedema, which causes fluid buildup around the scrotum. Previous surgeries or complications from surgical procedures may also contribute to this condition.

• Sagging or enlarged scrotum: Some individuals seek scrotoplasty for aesthetic reasons, such as a scrotal lift to address a sagging or loose scrotum. This procedure is particularly common among older adults, as the scrotum may naturally droop with age due to a loss of muscle tone.

Scrotoplasty can also be used to reduce the size of an enlarged scrotum, which can cause discomfort during sexual activity, exercise, or other physical activities due to its interference.

• Webbed penis: In some individuals, a band of skin connects the scrotum to the shaft of the penis, creating a webbed appearance known as penoscrotal webbing. This webbing can sometimes affect sexual function and penetrative intercourse. As a result, some people choose for scrotoplasty to improve both function and appearance for cosmetic reasons.
• Gender affirmation: Scrotoplasty can be part of gender affirmation surgery, where surgeons create a scrotum using the patient’s existing tissue. This procedure helps individuals align their physical characteristics with their gender identity.
• Skin infection: Fournier’s gangrene, a severe bacterial infection that can lead to the death of skin around the penis and scrotum, may require multiple surgeries. Scrotoplasty can assist in reconstructing the scrotum after such infections.
• Trauma or injury: Scrotoplasty can be used to repair damage to the scrotum resulting from trauma or injury.

Risks

Scrotoplasty carries some risks, including:

• Allergic reactions to anesthesia
• Infections
• Bleeding, bruising, and swelling
• Potential damage to the urinary tract
• Nerve injuries
• Pain during intercourse
• Scarring or cosmetic issues

For scrotoplasty performed as part of gender affirmation surgery, additional complications may include:

• Abnormal connections between the urethra and the skin.
• Exposure or displacement of testicular implants
• Rejection of transplanted tissue used to create a penis

It’s essential to thoroughly discuss these risks and all available options with your healthcare provider before proceeding with the surgery, regardless of the reason for the procedure.

Before the procedure

Your healthcare provider will give you specific instructions on what to do and avoid before surgery. For adults undergoing scrotoplasty, you should:

• Discontinue medications that can increase bleeding risk, such as blood thinners (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (NSAIDs), a few days to a week before surgery. Inform your provider about all medications and supplements you are taking.
• You should refrain from eating and drinking for eight to twelve hours prior to surgery to prevent complications with anesthesia.
• Arrange for someone to drive you home after the procedure, as you will be under the effects of pain medication and anesthesia.

For gender affirmation surgery, additional preparations may be necessary. Work closely with a trusted healthcare provider to understand the risks and benefits associated with all surgical options.

During the procedure

The specifics of your scrotoplasty will depend on your individual situation and anatomy, however, a scrotoplasty for conditions such as a buried penis or a sagging scrotum may involve the following steps:

• You will receive either general anesthesia (which makes you unconscious) or local anesthesia (which numbs the scrotum while keeping you awake).
• The surgeon will make an incision near the junction of your penis and scrotum.
• Excess skin and tissue connecting your skin to the penis will be removed.
• The surgeon may tighten the skin that connects the scrotum to the base of the penis.
• The incision will be closed with dissolvable stitches.
• A drain might be placed in the scrotum to help reduce swelling.

For gender affirmation surgery, which often involves creating a penis, general anesthesia is used due to the complexity of the procedure. A surgeon may create a penis by using existing genital tissue from the clitoris in a procedure called metoidioplasty. Alternatively, phalloplasty involves using skin from another part of your body to form a penis.

To create the scrotum, the surgeon will cut and shape the lower portion of the labia majora into a sac resembling the scrotum. The labia majora are the prominent, fleshy folds that surround and protect the vagina.

After healing, you may choose for testicular prostheses (implants) in a separate procedure. These silicone gel or saltwater implants mimic the appearance and feel of testicles.

The duration of the surgery varies based on the reason for the scrotoplasty. A procedure for conditions like buried penis or sagging scrotum is generally shorter, typically lasting at least one hour. In contrast, surgeries involving the creation of a scrotum or penis may take six hours or more.

After the procedure

Post-surgery care for scrotoplasty varies depending on the reason for the procedure:

• Generally, scrotoplasty for medical conditions is performed as an outpatient procedure, meaning you can return home the same day. However, surgery for a buried penis might require a hospital stay if it is more complex. For gender affirmation surgery, a hospital stay of a few days may be necessary for monitoring.
• Your surgeon will schedule a follow-up appointment within a few weeks to assess your recovery progress.
• It’s normal to experience some pain and swelling for a few days after surgery. Cold compresses and over-the-counter pain relievers can help alleviate these symptoms. Your provider will recommend specific medications or may prescribe pain relievers if needed.
• You should avoid sexual activity for at least two to three weeks post-surgery. Your healthcare provider will provide detailed aftercare instructions to support your recovery.

Outcome

The benefits of scrotoplasty primarily enhance quality of life and emotional well-being, including:

• Increased self-esteem: Many individuals experience a boost in self-esteem and satisfaction with their sexual relationships when they feel more comfortable with the appearance of their scrotum.
• Improved urinary function: For those with a buried penis, scrotoplasty can alleviate difficulties with urination and reduce urine leakage, leading to a better quality of life.
• Achieving gender affirmation goals: For individuals undergoing gender affirmation, scrotoplasty helps them move closer to their desired gender identity, contributing to greater personal comfort and alignment.

Post-surgery, you may need to stay in the hospital for a few days depending on the extent of the procedure. In some cases, you can go home within a few hours. Your healthcare team will ensure your recovery is progressing well before discharge.

During recovery, you might have:

• Support garment: You may be given a jockstrap or other support garment to prevent shifting of the scrotum.
• Catheter: A catheter might be used to drain urine from your bladder for several weeks while healing.
• Swelling and pain: Expect scrotal swelling and mild testicular pain that could persist for a few months.

Contact your healthcare provider if you experience:

• Chest pain or irregular heartbeats
• Difficulty urinating, painful urination, or blood in urine
• Fever
• Signs of infection, such as oozing or discoloration at the surgical site or around the catheter.
• Nausea and vomiting
• Shortness of breath