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What to Know About Scrotoplasty

Reviewed by Dan Brennan, MD on April 14, 2021

Scrotoplasty is a surgery that corrects or creates a scrotum. There might be many reasons why you have a scrotoplasty.

What Is Scrotoplasty?

Sometimes babies are born with birth defects that affect the scrotum. Sometimes people need or want a scrotoplasty for other reasons. A scrotoplasty is a type of scrotum surgery that fixes an existing scrotum or makes a new one.

A scrotoplasty might be done for:

  • Gender affirmation
  • Injury
  • Birth defects
  • Skin tightness
  • Skin looseness
  • Medical infections that cause skin or tissue loss
  • Large scrotum

The scrotum is a sac that hangs on the outside of the boy beneath the penis. It protects the testicles and keeps them at a lower temperature, which helps make sperm. Sometimes, things can happen where this sac needs surgical correction.

Penoscrotal web. Sometimes babies are born with the skin of the scrotum attached too far up the shaft of the penis. This is called webbing, but it can also be caused by circumcision. Webbing can reduce the penis angle, your perception of its length, and affect penetration during sex. It can cause discomfort and profound self-esteem problems for some people.

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Trauma or injury. Injury caused by a burn, animal or human bite, stab wounds, or blunt force damage can cause skin loss or problems with scrotum function. A scrotoplasty might be done to fix the skin and the scrotum.

Genitallymphedema. Sometimes radiation, infection, or cancer can lead to swelling from an abnormal accumulation of lymph in the penis and scrotum. Tissue might need to be removed from the scrotum to repair the function.

Genital cancers. If you get testicular cancer, your doctor may want to perform surgery to remove any masses. This can cause skin loss and your doctor may do a scrotoplasty to repair it.

Looseness. Sometimes the scrotal skin becomes loose and saggy with aging. A scrotoplasty can remove some of this excess skin and tighten up the scrotum. This is considered a cosmetic surgery.

Fournier gangrene. This rare condition is caused by necrotizing fasciitis — a serious skin infection that can affect the penis and scrotum. This can happen after an injury, a surgical procedure, or other urological infections and causes the tissue to die. Sections of the dead tissue might need to be removed. This can involve a scrotoplasty procedure.

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Gender-affirming surgery. During female-to-male transition, you might have a phalloplasty along with a scrotoplasty. These procedures create a penis and a scrotum and might use testicle implants. The scrotum is usually made from vaginal tissue.

Buried penis. This condition can happen in babies and adults. Babies might be born with a penis that is hidden by extra skin or by too much fat in the pubic area. Scarring from circumcision can also make the penis contract and be hidden. A scrotoplasty can remove some of this skin and reshape the scrotum.

Adults can also have a buried penis, which can be caused by obesity and extra fat. With obesity, you might have lots of abdominal and pubic fat and fungal infections that keep coming back. These can cause scarring and a buried penis.

During an erection, a buried penis can tear and bleed and be painful as the skin stretches. A scrotoplasty might help.

Enlarged scrotum. You might find exercise, movement, sex, and other activities uncomfortable and even painful if you have a large scrotum. A scrotoplasty can help remove some of the excess.

Impact of a Scrotoplasty on Your Health

A scrotoplasty is a delicate procedure. Having scrotal or penis problems can significantly impact your quality of life and self-esteem. For some people, cosmetic surgery that lifts a sagging scrotum might help with more self-esteem.

Gender-affirming surgery involves many steps and lots of different procedures, but it can also profoundly change mental health and quality of life.

Risks of Scrotoplasty

Surgical procedures always carry some risk. A cosmetic scrotoplasty that only removes extra skin might have very few complications. But sometimes surgery can cause other problems.

There are risks and side effects of having a scrotoplasty, including:

  • Infection
  • Nerve damage
  • Skin graft failure
  • Damage to your urinary tract
  • Scarring
  • Painful sex
  • Problems with sex
  • Bad bruising

Depending on the reason for your scrotoplasty, you might also need to have many more procedures. If you need a skin graft and there’s a problem with it, you might need to have more surgeries to correct it.

Keeping your surgery site clean and avoiding activity for a few weeks can help you avoid complications after a scrotoplasty. Your doctor might suggest you wear a jockstrap or tight-fitting underwear for support.

Sometimes there might be other kinds of procedures that can fix a problem with your scrotum. It’s important to fully discuss your options and your risks and benefits with your doctor.

WebMD Medical Reference

Sources

SOURCES:

Aesthetic Plastic Surgery: “Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults.”

Central European Journal of Urology: “Surgical management of buried penis in adults.”

Lurie Children’s Hospital of Chicago: “Buried Penis.”

National Organization for Rare Disorders: “Fournier Gangrene.”

Plastic and Reconstructive Surgery Global Open: “Labia Majora Flap Scrotoplasty and Perineal Reconstruction in Phalloplasty Patients: Technique and Outcomes.”

Translational Andrology and Urology: “Scrotal reconstruction and testicular prosthetics.”

Vancouver Coastal Health: “Scrotal Surgery.”

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