Nov 7, 2021 | Scrotum

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Scrotoplasty is an invasive surgical procedure that aims at repairing existing scrotum or creating a new scrotum for those who need one.  The procedure can be performed in infants, children or adults as needed.

What is scrotum and what is its function?

Scrotum is a bag/sack like organ mostly made with skin and few muscles that exists in males under the penis. The primary function of the scrotum is to hold the testicles (mostly two and in some cases one) that produce the male reproduction enzymes, the sperms. The scrotum is placed outside the body because, effective sperm production can happen at a temperature that is around 5 degrees centigrade less than normal human body temperature. The scrotum looks like a skin that is heavily folded, the reason for this is to give more surface area to the scrotum to release heat and keep it cooler.

Typically the scrotum is loose and sags a little. In certain conditions like stimulation or during ejaculation or in cooler temperatures, it is pulled up (closer to the base of penis) and becomes tighter.

Who can opt for scrotoplasty?

  1. Men who have a larger scrotum that causes discomfort.

A larger than normal scrotum makes it difficult for the person to sit comfortably, to work or to have sex or to workout. They even have discomfort wearing clothing of their choice. Such men are good candidates for reducing the size of scrotum to normal size.

  1. Transitioning females to males for gender affirmation

Females who want to transform their body into male to be in sync with their mind are also good candidates for scrotoplasty. However, we strongly advice such people to have detailed discussion with our sexologists regarding gender identity disorder and only upon confirmation by specialists to opt for having a new scrotum.

  1. Scrotum damaged or injured in an accident

Tearing or injury to scrotum may happen during accidents. Such men can go for getting their scrotum repaired. If the testicles are damaged or needs to be removed, the sexologist would recommend the same and may also replace the testicles with artificial ones so that the scrotum looks normal.

  1. Buried penis

Excess scrotal skin can make the penis appear as buried in it. In such cases, the excess skin is removed and the scrotum is reshaped to make it look normal.

  1. Sagging scrotum

Scrotum typically sags and with age, the sagging increases as the muscles lose their strength. Some men are not ready to accept the same and want their scrotum to look younger and more firm. Such men are also good candidates for scrotal lift or scrotoplasty.

  1. Penoscrotal webbing

In some males, the skin that connects the penis and the scrotum on the backside extends and will need a correction. The condition is called ‘penoscrotal web’, men suffering from such condition are right candidates for scrotoplasty.

What is done during a scrotoplasty procedure?

The procedure done during a scrotal lift (one type of scrotoplasty) is different from that of gender affirmation scrotoplasty.

Scrotal lift procedure

  1. The procedure is typically done under local anesthesia. Twilight anesthesia may also be given if the scrotal life involves tightening of the ‘cremaster muscle’. Cremaster muscle is responsible for pulling up the scrotum during stimulation or in cold etc.
  2. A small incision is made at the base of the penis and excess skin is removed.
  3. A small amount of skin is taken from other part of the body to add as reinforcement in cases when the sagging is too much.
  4. The incision is closed with dissolvable stitches.

Gender affirming scrotoplasty

Plastic surgeons or sexologists, while creating a new scrotum, they often combine the procedure with creating a new penis. New penis is made using two methods:

  1. Metoidioplasty – Existing genital tissue is used to create a new penis
  2. Phalloplasty – Skin is taken from a different part of the body to create a new penis.

When creating a new scrotum, the labia majora and the flaps of the vagina are modified to create a sac. Labia majora is fused and the flaps are turned upwards to make up the scrotum. Testicular implants may come in later (typically after few months) once the scrotal area is well healed.

What can you expect after scrotoplasty surgery?

  1. Scrotal lift procedure

Less sagging of scrotum should be obvious after scrotal lift procedure. However, there may be a little sag after few days after the procedure but surely not as much as it was before the surgery.

  1. Female to male transition surgery

A new scrotum like organ can be seen in place of vagina. Minor injuries to the operated area are common and are usually treated during the course of healing.


Complications of scrotoplasty surgery

  1. Failure of skin graft and muscles to survive.
  2. Damage to urinary tract or to the nerves is very much possible. The more the experience of the plastic surgeon, the less chances of damage to other areas of the body.
  3. Possible infection
  4. Painful intercourse

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