Instead a scalpel or occasionally a dermal punch is used to make an incision, which is then followed by suturing the front to the back in order to create a viable fistula.

Transscrotal piercings are usually healed with a barbell although teflon, tygon or other flexible inert jewelry can also be used.

Once healed, transscrotal piercings can be stretched quickly and, given the amount of surrounding tissue, to great size if desired.

A variety of jewelry can be used in healed transscrotal piercings, including large captive bead rings and plugs.

Like other "heavy" genital modifications, it may be performed under less than ideal situations by amateur practitioners as part of CBT or other BDSM activities.