What Is Scrotox and Why Would You Get It?

Key Points

• Is there a way to get the wrinkles out of your scrotum? Yes, there is.
• Scrotox, or scrotal Botox, can help smooth your scrotum and reduce testicle sweat.
• Scrotox is a safe, relatively simple procedure that relaxes the muscles of the scrotum.

Every summer, air conditioner repair people, roofers and other manual laborers come to the office to see Atlanta-based urologist Tariq Hakky, M.D. They're seeking Botox treatment for excessive sweating. But it's not for their armpits or palms. It's for their sweaty balls.

"Some guys are like, 'My balls are so sweaty that it looks like I'm pissing my pants,'" Hakky said.

Scrotal Botox—aka scrotox—involves injecting botulinum toxin (Botox) into the scrotum, the sac of skin that holds the testicles in place. Botox blocks the nerve signals responsible for sweating, which causes the sweat glands to produce less sweat.

Scrotox can be used for cosmetic reasons in men who desire a smoother scrotum with fewer wrinkles. It can make the balls hang lower and appear larger, too.

Can you Botox your balls?

Botox is not limited to smoothing the wrinkles of the face. You can Botox your scrotum as well. Botox is injected into the muscle fibers contained in the scrotum, namely the dartos and cremaster.

The dartos is a smooth muscle sheet that is located underneath the skin of the scrotum and that contracts to wrinkle the scrotal skin.

The cremaster is the striated involuntary muscle that covers the testes and spermatic cord. It's responsible for raising and lowering the testicles. The dartos and cremaster work together to maintain the temperature of the testicles.

What is scrotox and what is it used for?

Scrotox, or scrotal Botox, is a minimally invasive treatment that relaxes the muscles of the scrotum.

In addition to treating excessive scrotal sweating and reducing wrinkles, scrotox may be administered for scrotal pain. However, Laurence Levine, M.D., a professor of urology at Rush University Medical Center in Chicago, said he was not convinced of its efficacy for pain.

"I would call it experimental at best," Levine said.

Botox cord blocks were administered to men as part of a 2014 pilot study. The shots provided pain reduction for at least three months for most men with chronic scrotal pain, the study's findings suggested.

A different study—this one a randomized, double-blind controlled trial—suggested that Botox and local anesthesia did not provide scrotal pain relief any better than local anesthesia alone.

"I think scrotal Botox is more in the plastic surgery cosmetic realm," Hakky said. "In my experience, it's more about decreased sweating and reducing wrinkles. I think it's more for aesthetic appearances and less for pain."

What are the possible risks of getting Botox in your balls?

Patients may experience bleeding, pain, and soreness at the injection site and surrounding area. It's not uncommon for patients to get a small bruise at the injection site. There's a risk of infection as well, said Asaf Yalif, M.D., a plastic surgeon in Atlanta.

"If you are deep to the cremaster, there is a small risk that you can hit something that's present that you don't want to hit," Yalif said. "The only things in that area are the testicle, some blood vessels and the vas deferens."

Because Botox needles are so tiny, Yalif said it's very rare that he does not hit the intended target.

Hakky will give patients antibiotics to prevent infection and anti-inflammatories for swelling.

Botox could lead to systemic spread, causing difficulty breathing, speaking and swallowing, among other side effects, but this is rare.

"The downside of Botox is it's somewhat of a crapshoot as to where you inject; it's a broad sheet of muscle that is under the skin of the scrotum," Levine said. "And it's not like there's just one insertion site or one nerve that you would hit, so getting good relaxation may be difficult to accomplish."

Botox has a limited duration. Once the medicine is metabolized and wears off, the issue will recur. Scrotox generally lasts anywhere from four to nine months.

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Are there potential benefits to getting Botox injections in your scrotum?

Potential benefits of scrotox include the following:

• Reduced wrinkles
• Decreased sweating
• Lower hanging testicles
• Larger appearing testicles
• Pain relief

Scrotox makes the balls appear smoother, Yalif said. The scrotum is naturally wrinkly due to the rugae.

"You're still going to have lines because no matter what, the lines have been made your whole life," Yalif explained. "Even when you're a baby, your testicles and the cremaster reflex is intact and has been doing that job for however long your life [is] by the time you get the scrotox. But what it will do is make it smoother, less tight."

Who gets scrotox?

Men who have an excessively sweaty scrotum and men who are unsatisfied with the appearance of their balls will seek scrotox. The procedure can make the balls appear smoother and larger.

Anecdotally, Hakky and Levine said they find scrotox to be most popular among gay men.

"I've had guys come in and say, 'What can you do to make my testicles look bigger?' I think there's certain patient populations out there that think that having big balls is good," Levine said.

A wide range of men get scrotox, Yalif said. It's most common among men in their 20s and 30s, but Yalif has performed scrotox on men in their 60s.

Yalif has a few patients who work in the adult film industry and they want their balls to have a certain aesthetic for their sex scenes.

How do you get scrotox?

Scrotox is offered by certain urologists and plastic surgeons. While it's not yet widely available, the procedure is growing in popularity.

See a board-certified medical doctor who has experience with this procedure. Insurance does not typically cover scrotox. Yalif and Hakky both charge about $1,000 per ball.

What happens during a scrotox procedure?

A topical anesthetic will often be applied before the scrotox injection because the scrotum is a sensitive area. The anesthetic application will take about 20 minutes, according to Yalif.

After the area has been numbed, the actual scrotox procedure is a nonsurgical outpatient procedure that takes approximately 15 minutes. Botox is injected with a tiny 6- to 8-millimeter needle. About 100 to 200 units of Botox are applied per ball.

The bottom line

Scrotox is a safe option for men with excessive sweat in the groin region and men seeking cosmetic improvements to their scrotum. Its efficacy for scrotal pain is less proven.

Scrotox is expensive, and its effect is temporary. Guys seeking a permanent solution to their scrotal appearance may want to consider scrotoplasty.