SCROTAL SURGERY
GENDER-AFFIRMING SCROTAL SURGERY | SCROTOPLASTY
Scrotoplasty is a type of gender-affirming bottom surgery that involves creating a scrotum. It is often done as part of a larger surgical process, such as with phalloplasty or metoidioplasty, but it can also be done on its own depending on a person’s needs and goals.
Scrotoplasty and other gender-affirming surgeries are important for many transmasculine and nonbinary people. Gender-affirming procedures can support a more comfortable relationship with one’s body and, for some, help reduce gender dysphoria. [1]
It’s important to know that there’s no standard path in transition. Each person’s goals are personal and valid, whether or not they choose surgery. But for those who do, gender-affirming scrotal surgery can be a powerful and affirming choice that supports their sense of self.
Editor’s note: In our article, we may use terms that are culturally outdated, as many of our patients still rely on them when searching for information. We want to ensure we remain visible to this audience as well.
PATIENT STORIES
Choosing Align Surgical for your gender-affirming care means entrusting your health and identity to a skilled, compassionate team. Hear firsthand from patients who’ve experienced expert care from our renowned doctors.
WHAT IS SCROTOPLASTY?
Scrotoplasty is a surgical procedure that creates a scrotum, often using tissue from the labia majora (the outer folds of skin around the vagina). This surgery is a common part of gender-affirming bottom surgery for transmasculine, nonbinary, and other gender-diverse individuals who want a more masculine or affirming appearance in the genital area. [2]
Unlike traditional scrotal surgeries, which are performed for other medical reasons (like injury or cancer), gender-affirming scrotoplasty is focused on aligning a person’s body with their gender identity. It’s about comfort, body autonomy, and for some, the relief of gender dysphoria. [3]
Scrotoplasty may also include the placement of testicular implants, either at the same time or in a later surgery. [4] These are soft, rounded implants that give the scrotum a more typical shape and feel.
WHO MIGHT CHOOSE SCROTOPLASTY?
Scrotoplasty is an option for people who want to align their physical appearance more closely with their gender identity. This surgery is often chosen by transmasculine, nonbinary, or gender-diverse individuals who were assigned female at birth and are seeking a more masculine or affirming look in the genital area.
THE SCROTOPLASTY PROCEDURE: WHAT TO EXPECT
1) Consultation and Planning
Before surgery, you’ll meet with your surgeon to talk about your goals, health history, and options. They’ll explain the steps of the surgery, help you decide whether to include testicular implants, and talk about healing and risks. Experienced phalloplasty surgeons will perform the procedure so that the scrotum is in front of, rather than in between your thighs.
2) During the Surgery
In the operating room, the surgeon carefully reshapes tissue from the labia to form a natural-looking scrotum. If you choose to have testicular implants, they may be inserted during the same procedure or at a later time.
3) Anesthesia
Scrotoplasty is done under general anesthesia, so you’ll be asleep and won’t feel anything during the surgery.
4) Timeframe
The surgery usually takes a few hours, depending on whether it’s done alone or with other procedures. Most people stay in the hospital overnight or for a short time afterward to recover safely.
5) Recovery and Aftercare
You’ll need time to rest and heal. The surgical team will give you clear instructions about how to take care of your incisions, manage swelling, and watch for any signs of infection.
RECOVERY AND AFTERCARE
Recovering from scrotoplasty takes time and care. Knowing what to expect can help you feel more confident and prepared for this important step in your journey.
Right After Surgery
After surgery, you’ll likely spend some time in a recovery room or stay overnight in the hospital so the care team can monitor you. You’ll have bandages over the surgical site, and a catheter may be placed to help you urinate without straining.
Pain Management and Rest
It’s normal to feel sore, swollen, or tired for the first few days. Your surgeon will give you pain medications to help you stay comfortable. You’ll also need to take it easy, no heavy lifting, intense activity, or long walks for a few weeks.
Caring for the Surgical Site
You’ll get detailed instructions on how to:
1). Keep the area clean
2). Change your dressings
3). Watch for signs of infection (like redness, swelling, fever, or unusual drainage)
Following these instructions closely helps reduce the risk of complications and supports proper healing.
Follow-Up Appointments
Your surgeon will want to see you for several follow-up visits to check on your healing and answer any questions you may have. This is also the time to talk about when you can safely return to work or physical activities.
Healing Timeline
A). First 1–2 weeks: Rest; minimal activity; regular check-ups.
B). 3–6 weeks: Swelling and bruising go down; return to light activities.
C). 2–3 months: Most people feel fully recovered, though healing can continue for several more months.
Everyone heals at their own pace, so don’t compare your recovery to someone else’s.
TESTICULAR IMPLANTS AND APPEARANCE GOALS
Getting testicular implants during or after scrotoplasty can be an important step in creating a body that feels more aligned with gender identity. But this part of the surgery is optional and based on your personal goals.
What Are Testicular Implants?
Testicular implants are small, silicone-filled devices placed inside the scrotum to create a more natural, masculine appearance. They come in different sizes and shapes, and your surgeon can help you choose what feels right for you.
Some people choose to wait and get implants later, while others may decide not to have implants at all.
When Are Implants Placed?
1). During scrotoplasty: Implants can be inserted during your initial surgery if healing conditions are right.
2). Later, after healing: Some surgeons recommend waiting a few months so the tissue can heal before placing the implants.
This choice may depend on your overall health, the condition of the tissue, or your personal preferences.
Aesthetic Goals and Body Autonomy
Your scrotum doesn’t have to look one specific way. This surgery is about helping you feel more comfortable and confident in your body. You can talk openly with your surgeon about:
1). The look and feel you’re hoping for
2). Whether or not to include implants
3). Any concerns you have about size, placement, or sensation
At Align Surgical, care is centered around your identity, your values, and your comfort, not a one-size-fits-all approach.
UNDERSTANDING THE RISKS AND COMPLICATIONS
Like any surgery, scrotoplasty can come with some risks. It’s important to understand what might happen so you can feel informed and prepared. A good surgeon will talk through these risks with you and help you make the best decision for your body and goals.
Common Risks After Scrotoplasty
Some side effects and complications are more common after surgery. These may include:
- Swelling and bruising in the first few weeks
- Temporary numbness or changes in sensation around the surgical site
- Infection or poor healing, especially if the area isn’t kept clean
- Bleeding or fluid buildup (called a hematoma or seroma)
- Most of these issues are mild and go away with time or care from your surgical team.
Risks With Testicular Implants
If you choose to get implants, there are additional risks to know about, such as:
- Implant shifting or moving out of place
- Rejection (your body doesn’t accept the implant)
- Capsular contracture, where scar tissue tightens around the implant
- In rare cases, the implant may need to be removed or replaced
How to Reduce the Risk of Complications
Here are some ways you can optimize recovery:
- Follow all post-op instructions from your surgeon
- Keep the area clean and dry
- Avoid smoking or vaping, which can slow healing
- Rest and avoid heavy activity during the early recovery period
- Go to all your follow-up appointments
Choosing a qualified, experienced surgeon who offers gender-affirming care, like the team at Align Surgical also helps reduce risks and improve your experience.
CHOOSING A SURGEON
Picking the right surgeon for your scrotoplasty is a big decision. This is your body, and you deserve care that is respectful, affirming, and based on your needs.
What to Look For in a Gender-Affirming Surgeon
When researching providers, consider these important factors:
1). Experience with gender-affirming bottom surgery, especially scrotoplasty
2). A clear explanation of the surgical process and risks
3). Before-and-after photos of past patients (with consent)
4). Transparent information about healing, complications, and results
Clinics like Align Surgical specialize in gender-affirming procedures and share their approach and outcomes openly, helping you make an informed choice.
Inclusive and Affirming Care Matters
Look for a clinic that:
1). Respects your identity, name, and pronouns at every step
2). Understands the importance of safe inclusive care, meaning they work gently and without assumptions
3). Supports mental health and emotional well-being throughout your journey
A welcoming environment makes a big difference, especially during such a vulnerable and personal time.
Patient Testimonials and Reviews
Reading real experiences from other trans and nonbinary people can give you insight into how a clinic treats its patients and supports their journeys.
You can find testimonials directly on trusted clinic websites like Align Surgical or on trans healthcare forums and community platforms.
FINAL THOUGHTS
Taking the step toward scrotoplasty is an important part of many people’s gender-affirming journeys. It’s a choice that reflects your desire for a body that aligns with your identity, and it can be a powerful way to affirm your sense of self.
If you’re considering this surgery, it’s normal to have a mix of emotions. You might feel excited, nervous, or unsure. Remember, your journey is valid, no matter where you are in it. Whether you’re just starting to explore or you’ve already made the decision to move forward, you’re taking steps toward a future that feels right for you.
If you have questions or are ready to take the next step, Align Surgical Associates is here to help. We offer consultations, clear information, and compassionate care from experts who understand your needs. Don’t hesitate to reach out for support or to schedule a consultation to discuss your options in detail.
BY DR. MICHAEL SAFIR, MD
Dr. Michael Safir, MD is a board-certified reconstructive urologist in Los Angeles who specializes exclusively in genital gender-affirming surgery. With subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery (FPM-RS), Dr. Safir is one of the few urologists globally with fellowship training in both male and female genital reconstruction. He completed his undergraduate and medical degrees through the prestigious Honors Program in Medical Education at Northwestern University, where he also finished his urology residency. Dr. Safir pursued advanced training through fellowships in Male Genitourinary Reconstruction at UCSF and Female Reconstructive Urology at UCLA, under the guidance of renowned experts Dr. Jack McAninch and Dr. Shlomo Raz. He has held academic and leadership positions, including Section Chief of Reconstructive Urology at New York Medical College, President of the Los Angeles Urological Society, and Clinical Instructor at UCLA and UCSF. Board-certified by the American Board of Urology, Dr. Safir also serves as a Diplomate in FPM-RS and is an active member of the World Professional Association for Transgender Health (WPATH). Known for his compassionate care and surgical excellence, Dr. Safir is a trusted provider for individuals seeking scrotoplasty, phalloplasty, and other gender-affirming procedures.
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