Scrotoplasty

Gender-affirming scrotoplasty is one component of masculinizing gender-affirming genital surgery aimed at creating a scrotum with characteristics typical of a native scrotum. This procedure is typically combined with other masculinizing surgical interventions, most notably metoidioplasty or phalloplasty. Surgical centers may vary in their technique regarding conducting scrotoplasty in relation to other aspects of genital reconstruction, whether primarily as a single surgery or as part of a subsequently staged procedure. The same extends to placement of testis prostheses, if desired. Contemporary methods for scrotoplasty primarily consist of closing the labia at the midline or raising flaps constructed from the labia majora, which are embryologically homologous structures to the native scrotum. Such flaps can be inferiorly incised, raised, and rotated upward. Alternatively, they can be superiorly incised, inferiorly advanced, and closed in a V-Y manner. Furthermore, these two techniques can be combined, as is the author’s technique, albeit into a two-stage approach.