Scrotoplasty
Scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s.
Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition.
[3] Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection.
[4] For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function.
Scrotoplasty can be considered to remove excess skin in order to restore normal appearance of the scrotum and penis length, which can improve a man's confidence.
[6] Some trans men and intersex or non-binary people who were assigned female at birth may choose to have gender-affirming surgeries to create male genitals from existing tissue, as part of their female-to-male transition.
[7] Phalloplasty is the other type of surgery to create a penis, but utilizes skin from other areas of the body besides existing genitals.
[5] The first category of scrotal injury includes Fournier gangrene, which is a necrotic infection of the soft tissue around the genital.
To stop the necrotizing fasciitis from spreading, the treatment requires an aggressive surgical debridement which often results in the loss of the scrotal skin.
[4] Scrotal sagging can cause discomfort due to chafing of the scrotum against the body during every day activities and during exercise.
[12] Candidates must avoid any nicotine products, which can potentially affect wound healings and perioperative complications, for 3 months prior to the surgery.
For instance, a body mass index (BMI) of greater than 35 kg/m2 is contraindicated for radial forearm free flap (RFFF) phalloplasty.
[13] For gender-affirming scrotoplasty, people should have already been receiving hormone therapy for over 1 year with established mental and primary health care.
Scrotoplasty for transmasculine individuals is usually done with other gender-related genitourinary surgery (GRGUS), which consists of various procedures with variable personal desires for metoidioplasty, phalloplasty, vaginectomy, and urethroplasty.
However, the methods that give patients higher satisfaction are the single or double Z-plasty or V-Y advancement flap because they also can increase the penile length.
When a trans man or transmasculine person has a scrotoplasty, the labia majora (the big lips of the vulva) are dissected to form hollow cavities and united into an approximation of a scrotal sack.
[19][20] Most cases of gender-affirming scrotoplasty are done with Hoebeke's technique where the majority of people are satisfied with shape, size, and position of their newly constructed scrotum and consider getting prosthetic testicles and erectile inflatable devices .
[18] Later on, this technique was modified in which 1 silicone prosthetic testicle and an erectile inflatable device were implanted during the same surgery between 6–12 months after the initial scrotoplasty.
In general, post-operative hospital stays for people undergoing scrotoplasty range from days to weeks, corresponding to the complexity of the procedure.
Individuals with buried penis undergoing a scrotal lift can be discharged on the same day as procedure, and are not allowed to engage in sexual activities for many weeks.
[24] Another factor to consider is the loss of sensation in the scrotal area due to the nature of the procedure which can involve removal of genital tissues.
Once nerve tissue is reestablished with the body after a few months post-operation, sexual function may return to its full capacity.
In the United States, it is considered illegal for Medicaid, Medicare, and private insurance plans to deny individuals transition-related care coverage.
