Scrotox Injection Technique: A Guide for Performing Intrascrotal BOTOX® Treatment

Scrotox (also called BOTOX® for scrotum) is a procedure with both cosmetic and therapeutic applications. 

This guide provides a step-by-step approach to Scrotox administration, including pre-procedural patient positioning, anesthesia techniques, and injection protocols for both cremaster and dartos muscles. 

We also discuss indications for Scrotox, potential complications associated with the procedure, and its impact on male fertility.

Key Takeaways 

• Botulinum toxin injections in the scrotum are administered via intra-cremasteric injection protocol.
• Injections target the proximal third of the cremaster muscle and the deepest parts of the scrotal furrows in the dartos muscle.
• The procedure takes place under local anesthesia via spermatic cord block using lidocaine.
• Typically, 75 to 200 AIU of botulinum toxin is required for complete relaxation of the cremaster and dartos muscles.
• Effects of Scrotox injection are observed within 3 to 15 days and last for 3 to 6 months. Aesthetic improvements include scrotal relaxation and enlargement of the testicles.

What Is Scrotox?

Scrotox is a minimally invasive intrascrotal injection of botulinum toxin type A aimed to address both cosmetic and therapeutic concerns. The primary target of Scrotox is the dartos muscle, which causes scrotal rugosity when contracted. 

The treatment temporarily blocks the cremaster and dartos muscle contraction and reduces excessive sweat production by inhibiting the release of acetylcholine at the neuromuscular junction and nerve endings in sweat glands. 

There is a wide range of botulinum toxin type A products available in the market, including:

• BOTOX®
• XEOMIN®
• NABOTA®
• DYSPORT®
• BOTULAX®
• BOCOUTURE®

You want to compare the efficacy and safety profile of these products before choosing one for your patients.

Why Do Men Get Scrotox?

Men get Scrotox for both aesthetic and therapeutic reasons. Let’s take a look at both in more detail.

1. For Aesthetic Improvement 

Scrotox helps with the aesthetic refinement of the scrotal region. Botulinum toxin injections target the dartos and cremaster muscles and sweat glands to result in a smoother and more relaxed scrotal appearance. The procedure also reduces scrotal sweating and provides a tauter scrotal skin texture by eliminating rugae. 

This provides patients with a means to enhance their genital appearance, improves their self-perception and body image, and boosts self-confidence.

2. For Therapeutic Concerns

Scrotum BOTOX® also serves as an effective intervention for treating medical conditions like scrotal hyperhidrosis and chronic scrotal pain syndromes. 

Through the inhibition of acetylcholine release at the neuromuscular junction, botulinum toxin injections mitigate sweat gland activity, reducing excessive sweating in the scrotal region. This significantly alleviates the discomfort and embarrassment associated with scrotal hyperhidrosis and enhances the quality of life for patients. 

Scrotox has also been found effective for managing chronic scrotal pain by targeting sensory nerves. It provides symptomatic relief for individuals suffering from conditions such as orchialgia or epididymitis for up to three months. The literature also shows case reports of botox being used to treat scrotal dysesthesia refractory to conventional therapies. Plus, in select cases of severe and treatment-resistant cremasteric synkinesia, botulinum toxin type A injections directly into the cremaster muscle have shown promising results.

How Is Scrotox Administered?

Intrascrotal botulinum toxin is administered via the intra-cremasteric injection protocol. Here are the steps to follow during Scrotox injection:

Preparing for the Scrotox Injection Technique

Before administering Scrotox, make sure the patient is well-prepared. Begin by placing the patient in a supine position and disinfecting the treatment area thoroughly. 

Next, perform bilateral local anesthesia via spermatic cord block using a pure lidocaine injection (10 ml/1%) to ensure a painless procedure. Use a 5 ml syringe and a 4 cm 25G needle to inject lidocaine approximately 1 cm below and inside the pubic spine. After contacting the pubic bone, slightly retract the needle and perform a lidocaine injection following an aspiration test. 

Achieve complete anesthesia by injecting 3 to 4 mL boluses of lidocaine in various orientations around the spermatic cord and repeat the procedure on the other side. Each side may require 10 to 15 mL for complete anesthesia.

Administering the Scrotox Injection

Prepare a dilution of 100 Allergan International Unit (AIU) of botulinum toxin in 10 ml of injectable saline solution. 

Perform intramuscular injections at the proximal third of the cremaster muscle, where it is superficial and palpable. Administer two to three 3 mL intra-cremasteric injections (30 AIU) in the proximal third of the muscle in different axes to achieve complete muscular relaxation. 

Make punctual injections of 1 mL (10 AIU) or less into the dartos muscle in the most pronounced scrotal furrows. Repeat the procedure on the other side. 

Usually, 75 to 200 AIU of botulinum toxin is required to achieve complete relaxation of the cremaster and dartos muscles.

Results of Scrotox Injections

The effects of botulinum toxin injections are rapid and usually manifest within 3 to 15 days. 

For example, in a case report where Scrotox was performed on a 44-year-old patient for aesthetic reasons, relaxation of the cremaster muscle and scrotal expansion was noted upon evaluation ten days post-procedure. 

The patient reported a softer and smoother scrotum, with perceived enlargement of the testicles. High satisfaction was expressed regarding the aesthetic outcome; notably, the criterion “size of the testicles” improved from extremely dissatisfied to satisfied. 

The duration of intrascrotal botulinum toxin action spans three to six months and requires repeated injections for sustained effects. The patient in the case study above indicated a willingness to undergo subsequent injections as needed. At three months, the effects of Scrotox persisted, so a repeat procedure was performed six months later upon the decline of botulinum toxin efficacy. 

What Are the Risks of Scrotox?

Scrotox is a minimally invasive procedure, so it is generally safe and well-tolerated. However, it still carries the risk of complications that require careful consideration. Here’s the breakdown of Scrotox side effects: 

• Local injection reactions: The patient may experience temporary pain, discomfort, minor bleeding, bruising, and swelling around the injection sites. 
• Infection: As with any injection procedure, there’s a risk of localized infection if proper aseptic technique is not followed during the procedure. 
• Scrotal hematoma:  While rare, a scrotal hematoma can occur if a blood vessel is inadvertently punctured during the injection.
• Scrotal numbness: Temporary scrotal numbness can occur due to inadvertent injury to a scrotal nerve branch. In most cases, the sensation returns within 48 hours. Prolonged numbness requires further evaluation to rule out significant nerve damage.
• Disruption of thermoregulation: Scrotox’s mechanism of action involves relaxing the dartos muscle, which plays a role in scrotal thermoregulation. The temporary disruption can affect sperm health, as spermatogenesis is most efficient at cooler temperatures. 

Does Scrotox Affect Male Fertility?

The effect of Scrotox on male fertility in humans remains a subject of investigation, but animal models have shown that the treatment has potential adverse effects on spermatogenesis. 

For example, according to a 2014 study, rats receiving higher doses of Scrotox (20 and 40 U/kg) exhibited a significant decrease in sperm count and motility compared to the control group. 

The histopathological examination revealed disrupted seminiferous tubules with increased intertubular fibrosis in toxin-injected rats. Flow cytometry further confirmed a decrease in the population of mature sperm in rats receiving BOTOX® injections. 

The study raises valid concerns about the potential disruption of spermatogenesis by Scrotox due to disrupted thermoregulation and local diffusion. But larger studies on humans are needed before we can say anything for sure.

Is Scrotox Permanent? 

No, Scrotox is not permanent. Evidence suggests scrotal aesthetic and therapeutic effects last between three and six months.

Over time, the body naturally breaks down the botulinum toxin, which allows the nerve signals to return to the muscle and cause it to regain function. This means the scrotal skin will gradually return to its pre-treatment appearance.

Scrotox Injection Technique Simplified

To sum up, scrotal BOTOX® is a unique approach to both cosmetic enhancement and therapeutic relief for men seeking to address scrotal concerns. 

However, for successful Scrotox procedures, choosing high-quality botulinum toxin is crucial. Doctor Medica offers a comprehensive selection of BOTOX® products to keep your patients safe and satisfied.

Visit our website or contact a representative today to learn more about acquiring genuine botulinum toxin products for safe and effective Scrotox treatments.

References

• Khambati A, Lau S, Gordon A, Jarvi KA. OnabotulinumtoxinA (Botox) nerve blocks provide durable pain relief for men with chronic scrotal pain: a pilot open-label trial. J Sex Med. 2014;11(12):3072-3077. doi:10.1111/jsm.12707
• Raef HS, Elmariah SB. Treatment of male genital dysesthesia with botulinum toxin. JAAD Case Rep. 2021;10:60-62. Published 2021 Feb 3. doi:10.1016/j.jdcr.2021.01.018
• Mori R, Vasavada S, Baker D, Sabanegh E Jr. Treatment of debilitating cremasteric synkinesia with intracremasteric botulinum-A toxin injections. Urology. 2011;78(1):214-216. doi:10.1016/j.urology.2011.03.011
• Ramelli E, Brault N, Tierny C, Atlan M, Cristofari S. Intrascrotal injection of botulinum toxin A, a male genital aesthetic demand: Technique and limits. Prog Urol. 2020;30(6):312-317. doi:10.1016/j.purol.2020.04.016
• Breikaa RM, Mosli HA, Nagy AA, Abdel-Naim AB. Adverse testicular effects of Botox® in mature rats. Toxicol Appl Pharmacol. 2014;275(2):182-188. doi:10.1016/j.taap.2014.01.003