Scrotoplasty is a surgical procedure used to either repair or treat an existing scrotum or to create a new scrotum.

Scrotoplasty may be performed for infants with birth defects that affect scrotum anatomy or function, but may also be performed in adults for:

  • gender affirmation
  • cosmetic reasons, such as scrotum skin tightness
  • medical reasons, such as injury or congenital defects

It’s important to understand the risks associated with scrotoplasty. Follow your surgeon’s recommendations before and after this delicate procedure, especially if you’re opting to have one for cosmetic reasons.

You should also have a realistic idea of what to expect when the surgery has been performed and recovery is complete. And as with any surgery, take the time to choose an experienced doctor who understands your concerns.

Your scrotum is a sac of skin and muscle located beneath your penis. The main function of your scrotum is to surround and protect testicles or testicular implants in those who have had gender-affirming surgery.

Your scrotum also lets your testicles hang away from your body and keep a lower temperature (about 93.2ºF) than the rest of your body (around 98.6°F). This creates ideal conditions for sperm production.

The shape and skin texture of your scrotum also changes throughout the day and night in response to various stimuli.

During sexual stimulation, exercise, or cooler temperatures, your scrotum contracts closer to your body. When your body is warmer, your scrotum relaxes and elongates.

There are a few scenarios in which a scrotoplasty may be recommended. Here are some of the primary reasons that many people seek out scrotoplasties.

Scrotum sagging with age

As a person with a penis gets older, their scrotum’s muscle tone weakens. This means that it can “sag” lower than it did earlier in life.

Older adults with low-hanging scrotums may be good candidates for a scrotoplasty known as a scrotal lift.

Enlarged scrotal sac

Some younger individuals also may have enlarged scrotal sacs that they find uncomfortable during sexual activity, sports and exercise, or simply when wearing loose-fitting clothing.

A scrotoplasty can help reduce the size and sag of your scrotum to help reduce discomfort.

Penoscrotal webbing

Scrotoplasty may also be appropriate for people with a condition called penoscrotal web. This happens when your skin connecting your penis to your scrotum extends along the underside of your penis shaft like a web.

A penoscrotal web is not usually a serious medical condition. But a 2017 research review suggested that it can affect sexual self-esteem and that scrotoplasty may be an appropriate remedy.

Buried penis

Scrotoplasty may be done when the penis of a young infant is attached to their scrotum with an excess of skin. This condition is known as buried penis.

Scrotoplasty in infants involves cutting away extra skin from their penis and reshaping their scrotum.

Female-to-male (FTM) transition

Other good candidates for scrotoplasty are individuals seeking gender affirmation surgery for a female-to-male transition.

In these cases, surgeons aren’t reshaping an existing scrotum, but rather creating a new scrotum from existing tissue.

According to the American Society of Plastic Surgeons, good candidates for female-to-male surgical procedures include those who have been:

  • living as a member of their desired sexual identity
  • diagnosed with persistent gender dysphoria
  • evaluated by two mental health professionals who can provide recommendations supporting the decision

Cosmetic reasons

Some individuals seek out scrotoplasty for aesthetic reasons — they simply want their scrotums to look a certain way or achieve a desired look that they or their sexual partners may find attractive.

A 2020 report noted that there has been relatively little research examining the effectiveness of scrotoplasty for aesthetic purposes.

More reported experiences would be helpful for healthcare providers seeking a consensus on scrotal lifting as a safe and appropriate cosmetic procedure.

If you’re looking to change the size and shape of your scrotum, be sure to have frank conversations with your doctor about the risks and benefits involved.

Elective surgery of this kind typically isn’t covered by insurance if it’s done for cosmetic reasons. Be sure to know about the costs and coverage up front.

This also applies to individuals who want scrotoplasty as part of a female-to-male transition. There may be follow-up procedures and medical care involved that aren’t covered by some insurance plans.

Talking with those who have had the surgery as well as those who have considered it but chose not to go through with it may be helpful. Preparing mentally and emotionally is critical to achieving the outcome you desire.

Once you are ready for the surgery, you should:

  • Arrange to have someone drive you home. The anesthesia and pain medication will make driving on your own unsafe.
  • Tell your doctor about all medications and supplements you take. Ask which ones you can and cannot take in the days leading up to the operation. Aspirin or blood thinners, for example, raise your risk of bleeding complications during or after surgery.
  • Update your advance care plan. Make sure your doctor and hospital have a copy. This is true for any surgery or serious medical procedure you undergo.
  • Ask when you should stop eating and drinking prior to the operation.
  • Ask whether you should shave around the surgical site. It’s likely that will be done at the hospital prior to surgery.
  • Shower before your procedure. Don’t apply skin moisturizers, deodorants, or other skin care products.

The procedures for scrotal lifts and gender-affirmation scrotoplasty are very different.

Talk with your doctor about the steps involved in your particular procedure and what will be required during recovery.

Scrotal lift

The steps involved in this kind of scrotoplasty depends on how much reconstruction is necessary.

Here’s the basic procedure for a scrotal lift:

  1. You’re given a local anesthetic near your scrotum to numb the area. You may be given twilight anesthesia as well if you need a tightening of your cremaster muscle, which pulls your testicles up when your scrotum contracts.
  2. A small incision is made at the base of your penis to remove a small amount of skin.
  3. Excess skin is cut away.
  4. A skin graft taken from elsewhere on your body may be used if your skin and muscle of your scrotum have been stretched considerably and need reinforcement.
  5. When the surgery is complete, the incision is closed. This is usually done with dissolvable sutures.

Gender-affirming scrotoplasty

There are several approaches surgeons may take with those undergoing a female-to-male transition.

When scrotoplasty is done as part of female-to-male transition, it is often performed with other procedures (sometimes referred to collectively as sex reassignment surgery), such as:

The scrotoplasty portion of these procedures is often done as follows:

  1. You’re placed under general anesthesia.
  2. Incisions are made in the lower part of your labia majora and around your pubic bone.
  3. The flaps are turned upward to create a sac.
  4. The surgeon uses dissolvable sutures to attach the flaps in the shape of a scrotum.

Aftercare for a scrotoplasty may depend on the purpose of the scrotoplasty. Here’s what to expect for the two primary scrotoplasty procedures just covered.

Scrotal lift aftercare

For a scrotal lift, you can return home the same day as your procedure.

Follow-up visits with your doctor should be scheduled soon after surgery to check on your progress.

Expect pain and swelling to linger for a few days. Cold compresses and over-the-counter (OTC) pain relievers may be helpful during this time.

Your doctor will likely recommend avoiding sexual activity for at least 3 weeks.

Gender-affirmation surgery

Recovery after gender-affirmation scrotoplasty, especially if it was done in conjunction with other procedures, will take longer.

You will probably stay in the hospital for a few days at least, depending on how much surgery was done and if there were any complications.

A combination of prescription-strength and OTC pain relievers are usually recommended to help manage pain and discomfort following the procedure.

If you had a phalloplasty along with the scrotoplasty, you will probably have a catheter in place for a 3 to 4 weeks before having it removed at the hospital.

Pay close attention to your hospital discharge orders regarding bathing and changing the dressing on your surgical site or sites.

Desired results from a scrotoplasty may vary based on the purpose of the scrotoplasty. Here’s what to expect from a scrotal lift as well as a FTM transition surgery.

Results of scrotal lift

Scrotoplasty done as a scrotal lift should make your scrotum appear less saggy.

But due to the pull of gravity on your scrotum as well as the weakening of tissue and muscles, you may need a follow-up procedure at some point.

Results of FTM transition

When scrotoplasty is done as part of transmasculine bottom surgery, it may take some time for you to get used to having a scrotum.

A 2019 study found that minor wounds using the labia majora “flap” method are common but easily treatable. The formation of hematomas (collection of blood outside blood vessels) are rare.

Testicular implants may be provided once your initial surgery heals —typically several months later. You will notice scars at first, and while these scars fade over time, they may never completely disappear.

A 2019 research review also suggested that scrotoplasty and related surgeries can be helpful in “aligning body and mind,” with the physical body representing a person’s sense of gendered self.

Any type of surgery carries with it a risk of bleeding problems or infection.

Other risks associated with scrotoplasty include:

  • nerve injury
  • failure of transplanted skin and tissue to survive
  • scarring
  • injury to your urinary tract
  • painful or problematic intercourse
  • infection

Gender-affirmation bottom surgeries can sometimes require corrective surgery when complications arise. Prepare yourself with an understanding of these risks so that you can be ready to address them if necessary.

For individuals unhappy with the appearance of their scrotum, scrotoplasty isn’t the only option. A plastic surgeon may be able to discuss alternatives to scrotoplasty with you.

For example, a procedure known as scrotox can give your scrotum a less wrinkly, more filled-out appearance. This involves the injection of botulinum toxin (Botox) directly into your scrotum.

Is a scrotum necessary for gender affirmation?

Not all transgender men opt for scrotoplasty or other related procedures. Though having a scrotum may give you a more tangible sense of yourself as physically male, gender is both a societal and internalized identity.

Ultimately, you don’t need a scrotum or even a penis to identify as male and ask for others to treat you and consider you as such if that’s how you identify yourself.

Talking with others about gender affirmation and self-image as well as taking the time to consider all of your options can help you find a sense of confidence as a transgender male as you go through a FTM transition.

If the surgery is covered by your insurance, check to see if there are providers in your network.

You shouldn’t feel limited by the surgeons on your list of covered providers. But if cost is a consideration, insurance coverage should likely factor into your decision.

If your insurance won’t cover the procedure, take the time to find a doctor who is experienced and gives you confidence that the surgery will be successful.

Recommended specialists for scrotoplasty

  • plastic and reconstructive surgery
  • reconstructive urology
  • transgender surgery
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These specialists may be difficult to find at first, especially if you don’t live near a large city with a large population of medical specialists.

But keep looking around and ask doctors you know for recommendations. If you’re uncomfortable asking medical professionals for advice, ask people who have had similar procedures for their input and experiences.

The following resources may also be helpful:

Scrotoplasty can make a person feel more comfortable if their scrotum is too large or has become too lax. For transgender men, scrotoplasty can give you a scrotum as part of your broader goals for gender affirmation.

The key is to find a surgeon who has plenty of experience with the type of scrotoplasty you need and who will be honest about how your genitals will look and feel after the procedure as well as what risks are involved.