Scrotoplasty

What is scrotoplasty?

Scrotoplasty is surgery to treat a problem with your scrotum or form a new scrotum. This sac of skin and muscle located beneath your penis holds and protects your testicles. Your penis, scrotum and testicles are all part of the male reproductive system.

Who needs scrotoplasty?

Children and adults may need scrotoplasty. The most common reason for a child to need scrotoplasty is to treat a condition called buried penis. Buried penis is often present at birth (a birth defect). With buried penis, the penis is a typical size, but it looks smaller.

Transgender men may choose to get scrotoplasty as part of a gender affirmation (female-to-male) procedure.

Some people want a scrotal procedure for cosmetic reasons. Cosmetic scrotoplasty can lift a sagging scrotum (scrotal lift) or make the scrotum smaller.

What causes buried penis in children?

Most often, buried penis in children occurs because weak ligaments (tissues) don’t firmly connect their penis to their body. Circumcision that removes too much (or not enough) foreskin can also cause buried penis.

Some children have a longer-than-usual piece of skin that connects their scrotum and penis. This excess skin (called a penoscrotal web) covers their penis.

What causes buried penis in adults?

In older children and adults, buried penis can result from:

• Excess fat (obesity).
• Lymphedema (fluid buildup around the scrotum).

What happens before scrotoplasty?

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

• Avoid certain medicines that can increase bleeding risk a week or two before surgery. These medicines include blood thinners (aspirin or other medicines that prevent blood clots and strokes) and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Not eat or drink for a set period before surgery. Anesthesia is safer on an empty stomach.
• Cut back on alcohol, and quit using tobacco products. Alcohol and nicotine can slow postsurgical healing and increase the risk of complications.

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. A healthcare provider can help you understand the risks and benefits of all surgery options.

Many insurance companies require you to submit specific documentation before they’ll cover a gender-affirming surgery. This documentation includes:

• Health records that show consistent gender dysphoria.
• Letter of support from a mental health provider, such as a social worker or psychiatrist.

What happens during scrotoplasty to treat medical problems?

During surgery to treat buried penis or another problem, a surgeon removes excess skin and tissue connecting your skin and penis. If needed, the surgeon may tighten ligaments that connect your scrotum to the base of your penis.

What happens during scrotoplasty for gender affirmation?

Scrotoplasty for gender affirmation typically includes creating a penis. A surgeon may use existing genital tissue to create a penis (metoidioplasty). Or the procedure may take skin from another part of your body (phalloplasty).

To construct the scrotum, the surgeon cuts and shapes the lower part of your labia majora into a scrotum-like sac. The labia majora are the large, fleshy lips that enclose and protect external genitals. They are part of the female reproductive system.

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.

What are the potential risks or complications of scrotoplasty?

A scrotoplasty has some degree of risk, including:

• Allergic reaction to anesthesia.
• Bleeding, bruising and swelling.
• Damage to the urinary tract.
• Infections.
• Nerve injuries.
• Painful intercourse.
• Scarring.

What are the potential risks or complications of gender-affirming scrotoplasty?

Additional complications of scrotoplasty for gender affirmation include:

• Abnormal connection between your skin and urethra (the tube that carries urine out of your body).
• Breakthrough and exposure of the testicular implants.
• Rejection of tissue transplanted to create a penis.

What is recovery like after scrotoplasty?

Depending on the procedure’s extent, you may stay in the hospital for several days. Your healthcare team will make sure your recovery goes smoothly.

You may have:

• A support garment like a jockstrap to minimize movement.
• A catheter (thin tube) to drain urine from your bladder and out of your body. This catheter may remain in place for several weeks while your genitals heal.
• Scrotal swelling for several months, with mild testicular pain.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Chest pain or arrhythmias (heart rhythm changes).
• Difficulty urinating, painful urination or blood in urine.
• Fever.
• Nausea and vomiting.
• Severe
• Shortness of breath.
• Signs of infection (oozing and redness) 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 won’t cover cosmetic surgeries like a scrotal lift.

Coverage is more complex for people seeking gender affirmation surgery. 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

Most people who undergo scrotoplasty to treat a medical condition have full recoveries. Gender-affirming scrotoplasty is a more complex procedure with a longer recovery. People getting gender affirmation procedures receive care from many healthcare providers. These include mental health counselors, urologists and plastic surgeons. Your healthcare team can answer questions and concerns about this procedure.