Background: Patients may seek gender-affirming orchiectomy and scrotectomy (GAOS) to alleviate dysphoria related to the scrotum and testes, while allowing for penetrative intercourse, if desired. However, techniques and outcomes of scrotectomy in this specific setting have not been described to date. Here we discuss our initial experience with GAOS as an option for patients who do not necessarily desire other gender-affirming genital surgeries.

Methods: All patients who had undergone GAOS procedures from 2021 to 2022 at our institution were reviewed. The World Professional Association for Transgender Health (WPATH) criteria for surgical treatment were met for all patients preoperatively. In addition, patients were counseled on the irreversibility of the procedure and its implications, including sterility and the impact on future surgical options such as vaginoplasty. Patients were offered a choice of two approaches depending on their surgical goals: excision of a majority of scrotal tissue and primary closure of the perineal wound, or excision of all rugated skin with mons and groin (Y-flap) advancement. Preoperative demographic data, baseline sexual function, intraoperative findings, and postoperative outcomes were collected. Patient-reported outcomes (PROs) derived from the PROMIS ® Sexual Function questionnaires were sent to all patients postoperatively and collected.

Results: Five patients underwent GAOS during the study period. Median age was 29 years and median preoperative duration on hormones was 16 months. All patients reported dysphoria related to the scrotum and testes, and wished to preserve the phallus. Three of the five patients elected for primary closure, while two desired Y-flap perineoplasty. Median operative time was 152 min and median resected scrotal area was 96 cm2; all patients were discharged home the same day. At median follow up of 97 days, all patients reported satisfaction with the surgical outcome. One patient who had Y-flap experienced wound dehiscence requiring operative revision. Three of five patients completed detailed questionnaires regarding resolution of dysphoria and preservation of sexual function. All patients who experienced postoperative complications reported being sexually active with the ability to achieve erection and orgasm within the last thirty days of the survey collection, and no change to their libido. Further patient follow-up is being collected.

Conclusion: GAOS is a well tolerated procedure that can reasonably address dysphoria related to the scrotum and testes. Further and longer-term study of this emerging procedure is warranted.