Scrotoplasty

What is scrotoplasty?

Scrotoplasty is surgery to treat conditions that affect your scrotum or create a new scrotum. Your scrotum is a layered pouch beneath your penis that holds and protects your testicles.

Why would someone need a scrotoplasty?

There can be many reasons children and adults have a scrotoplasty. Some people are born with medical conditions that affect their scrotums, and others develop conditions in adulthood. Others may choose to alter or create a scrotum for other reasons.

Buried penis

Treating a condition called buried penis is the most common reason children need scrotoplasty. Buried penis is a congenital condition (something you’re born with) that causes your penis to appear hidden under the skin of your scrotum, thigh or abdomen. Most often, buried penis occurs because weak ligaments don’t firmly connect a child’s penis to their body. Circumcision that removes too much (or not enough) foreskin can also cause buried penis.

A buried penis in adults can also result from having obesity or lymphedema (fluid buildup around your scrotum).

Sagging or enlarged scrotum

Some people want a scrotal procedure for cosmetic reasons. Cosmetic scrotoplasty can lift a sagging or loose scrotum (scrotal lift). This type of scrotoplasty is more common in older adults when their scrotum naturally begins to sag as they lose muscle tone.

Scrotoplasty can also help people with a large scrotum by making it smaller. People with an enlarged scrotum may find sexual activity, exercise or other physical activities uncomfortable due to their scrotum getting in the way.

Webbed penis

Some people have a sail of skin connecting their scrotum to the shaft of their penis. It creates a web-like appearance (penoscrotal webbing). The webbing sometimes can impact sexual function and penetrative intercourse. This can lead people to choose scrotoplasty for cosmetic reasons.

Gender affirmation

People may want a scrotoplasty as part of gender affirmation surgery for a female-to-male transition. In this type of scrotoplasty, surgeons create a scrotum from your existing tissue.

Trauma or injury

Scrotoplasty can help repair a scrotum that’s damaged from trauma or injury.

Skin infection

A potentially life-threatening bacterial infection called Fournier’s gangrene can cause the skin around your penis and scrotum to die. Typically, you need multiple surgeries, and a scrotoplasty can help repair your scrotum.

How should I prepare for a scrotoplasty?

Your healthcare provider will tell you what you should and shouldn’t do before surgery. Adults having scrotoplasty should:

• Avoid certain medications. You should stop taking medicine that can increase bleeding risk a few days to a week before surgery. These medicines include blood thinners (aspirin or other medicines that prevent blood clots and strokes) and nonsteroidal anti-inflammatory drugs (NSAIDs). Be sure your provider knows about any medications or supplements you take.
• Avoid food and drink. Your surgeon may ask you to restrict food and beverages eight to twelve hours before surgery to avoid issues with anesthesia.

Since you’ll be taking pain medicine and feeling the effects of anesthesia, you should arrange to have someone drive you home after a scrotoplasty.

What happens before scrotoplasty for gender affirmation?

Besides medical preparation for surgery, there may be other things you have to do before getting gender affirmation surgery. Before surgery, you should work with a trusted healthcare provider. They can help you understand the risks and benefits of all surgery options.

What happens during scrotoplasty to treat medical conditions?

The steps of your surgery will vary depending on your situation and anatomy, but a scrotoplasty for a buried penis or sagging scrotum may go as follows:

• Anesthesia will be given either in the form of general anesthesia (unconscious for the surgery) or local anesthesia (numbing of the scrotum, but awake).
• An incision (cut) is made near the area where your penis and scrotum meet.
• Your surgeon will remove excess skin and tissue connecting your skin and penis.
• They may tighten the skin that connects your scrotum to the base of your penis.
• Your surgeon will close the incision using dissolvable stitches.
• A drain may be left in your scrotum to minimize swelling.

What happens during scrotoplasty for gender affirmation?

Scrotoplasty for gender affirmation typically includes creating a penis. A surgeon may use existing genital tissue from the clitoris to create a penis (metoidioplasty). Or the procedure may take skin from another part of your body (phalloplasty) to form a penis. Gender-affirming surgery uses general anesthesia due to the complexity of the procedure.

To construct the scrotum, your surgeon will cut and shape the lower part of the labia majora into a scrotum-like sac. The labia majora are the large, fleshy lips that enclose and protect the vagina.

After your scrotum heals, you may choose to get testicular prostheses (implants) during another procedure. These silicone gel or saltwater implants create the look and feel of testicles.

How long does a scrotoplasty take?

The length of time varies depending on why you’re getting a scrotoplasty. A scrotoplasty for a condition like buried penis or sagging scrotum is shorter than a scrotoplasty for gender reassignment. You can expect at least one hour for a scrotoplasty, but procedures that involve creating a scrotum or penis may take six hours or more.

Is scrotoplasty painful?

Your healthcare team will make sure you’re comfortable and don’t feel pain during the procedure. But you can expect some soreness and discomfort during your recovery.

What happens after a scrotoplasty?

What happens after a scrotoplasty varies depending on why you had one.

Typically, scrotoplasty for medical conditions is an outpatient surgery. This means you can go home the same day. Surgery for buried penis may require a hospital stay if a you need a longer surgery. For gender affirmation surgery, you may need to stay in the hospital for a few days for monitoring. Your surgeon will schedule a follow-up appointment within a few weeks to check on how your recovery is going.

You can expect to have some pain for a few days after surgery, and swelling may last for weeks. Cold compresses and over-the-counter (OTC) pain relievers can usually help with this. Ask your provider which medications they recommend. Your provider may prescribe pain relievers to help manage pain.

Your healthcare provider will ask you to avoid sexual activity for at least two to three weeks. They’ll also let you know of any aftercare instructions you should follow during your recovery.

What are the risks or complications of scrotoplasty?

A scrotoplasty has some degree of risk, including:

• An allergic reaction to anesthesia.
• Bleeding, bruising and swelling.
• Damage to your urinary tract.
• Infections.
• Nerve injuries.
• Painful intercourse.
• Scarring or cosmetic issues.

Additional complications of scrotoplasty for gender affirmation include:

• Abnormal connection between your skin and urethra.
• Breakthrough and exposure of the testicular implants.
• Rejection of tissue transplanted to create a penis.

No matter what the reason is for a scrotoplasty, you should make sure you discuss the risks and all your options with your healthcare provider before surgery.

What are the benefits of scrotoplasty?

Benefits of a scrotoplasty mainly affect people’s quality of life and emotional well-being. The benefits include:

• Increased self-esteem: People feel more comfortable and desirable when they’re happy with the look of their scrotums. It can lead to more satisfaction and happiness in your sexual relationships.
• Urinary function: Buried penis can lead to difficulty urinating (peeing) and leaking urine. Scrotoplasty may significantly improve your quality of life with urinating.
• Achieving your gender affirmation goals: People seeking gender affirmation are closer to reaching the identity they feel most comfortable in.

What is recovery like after scrotoplasty?

Depending on the extent of the procedure, you may need to stay in the hospital for a few days. In other cases, you can go home within a few hours of surgery. Your healthcare team will make sure your recovery is going well before they send you home.

You may have:

• A support garment like a jockstrap to stop your scrotum from shifting.
• A catheter (thin tube) to drain pee from your bladder and out of your body. You may need to use a catheter for several weeks while your genitals heal.
• Scrotal swelling for several months, with mild testicular pain.

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Chest pain or arrhythmias (heart rhythm changes).
• Difficulty peeing, painful urination or blood in your pee.
• Fever.
• Nausea and vomiting.
• Shortness of breath.
• Signs of infection (oozing and discoloration) at the surgical site or catheter.

Does insurance cover scrotoplasty?

Most insurance providers, Medicare and Medicaid cover the cost of scrotoplasty to treat medical conditions like buried penis. They usually won’t cover cosmetic surgeries like a scrotal lift.

Coverage is more complex for people seeking gender affirmation surgery. Many insurance companies require you to submit specific documentation before they’ll cover a gender-affirming surgery, like health records that show consistent gender dysphoria.

The law requires most private health insurers to cover medically necessary transition-related care. Medicare and Medicaid also provide this coverage. But there can be exclusions, and scrotoplasty might be one of them. You should check with your insurance provider about coverage. You can learn more at the National Center for Transgender Equality.

A note from Cleveland Clinic

You can have scrotoplasty to treat medical conditions or as part of gender affirmation. Both types of procedures are safe and successful most of the time. While there are risks to scrotoplasty, when surgery is warranted, the benefits of feeling confident after the procedure typically outweigh this. People getting gender affirmation procedures receive care from many healthcare providers. These include mental health counselors, urologists and plastic surgeons. Whatever the reason you’re seeking scrotoplasty, your healthcare team is here to answer your questions.