Best neurotoxin for Scrotox and Bocox?

Question

Is there a neurotoxin that works best for Scrotox for scrotal pain and for aesthetic results? Is there one that works best for use in ED for the penis?

Jason Emer, MD · Answer

Scrotox is a nonsurgical cosmetic treatment of the scrotum with neurotoxin injections. Botox is used to inject directly into the testicles to help decrease sweating, reduce wrinkles and make the scrotum appear larger due to the relaxation of the muscles. As a result, it improves the overall aestethic appearance of the penis. Neuromodulators take 2 to 4 weeks to start working and lasts for up to six months. I suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Anna Chacon, MD, FAAD · Answer

For Scrotox, there is some clinical evidence supporting onabotulinumtoxinA (Botox) for chronic scrotal pain, particularly when pain has responded to a diagnostic spermatic cord block. A small pilot study using Botox cord blocks found pain improvement in many patients for several months, although the evidence is still limited and the benefit generally diminished by around six months.

For the aesthetic Scrotox effect—relaxing the dartos/cremasteric muscles and creating a smoother or more relaxed scrotal appearance—the evidence is much less established. There isn't enough high-quality evidence to say that one commercially available neurotoxin is definitively “the best.” There are also still unanswered questions regarding fertility and reproductive effects with injections around the scrotum, so I would be particularly cautious in someone planning future fertility.

For “Bocox” or penile Botox for erectile dysfunction, there is promising research with botulinum toxin type A, including onabotulinumtoxinA. Studies have reported improvements in erection hardness and erectile-function scores, particularly in men whose ED has not responded adequately to PDE5 medications. However, this remains an off-label treatment, and the studies are relatively small and use different techniques and dosing protocols.

So, if we're talking specifically about the evidence today, Botox (onabotulinumtoxinA) has some of the clearest published clinical data for both chronic scrotal pain and investigational penile treatment, but I would not describe it as an established first-line treatment for either condition. The underlying cause of the pain or ED is important, and these treatments should be approached much more cautiously than routine cosmetic Botox.

Michael I. Echavez, MD · Answer

In my experience, I have not found that one neurotoxin necessarily gives a better result than another when treating the scrotum.  It is possible that Daxxify could give a longer result than the other neurotoxins, but I have not used Daxxify in the scrotum on anyone yet.  I also have not used neurotoxins for ED.

Best neurotoxin for Scrotox and Bocox?

Answers (3)

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