II. Exam: Female
-
Breast Buds and Galactorrhea
- Resolves in first month of life
- Consult pediatric endocrinology if persistent
- Labia
- Term infant: Labia majora prominent
- Preterm Infant: Labia minora and Clitoris prominent
- Vaginal Skin Tag or hymenal tag
- Normal and require no treatment
- White mucoid discharge or scant Vaginal Bleeding
- Normal withdrawal from maternal Estrogen in first 3-7 days of life
-
Ambiguous Genitalia signs (requires urgent urology/endocrine/Genetics consult prior to gender assignment)
- Fused labia
- Clitoromegaly
III. Exam: Male
-
Undescended Testes (Cryptorchidism)
- More common in Premature Infants
- Retractile Testes that can be milked into Scrotum do not require additional evaluation (only routine follow-up)
-
Communicating Hydrocele
- Processus vaginalis fails to close allowing free passage of peritoneal fluid into Scrotum
- Typically resolves spontaneously within first 1-2 years of life
-
Inguinal Hernia
- Complicates Communicating Hydrocele, with bowel passing into Inguinal Canal
- Risk of incarceration and Strangulation
- Hypospadias (with or without Chordee)
-
Chordee
- Ventral penile curvature
- Do not circumcise
- Buried penis
- Penis retracts into fat pad
- Do not circumcise (risk of entrapping glans penis with post-procedure swelling)
- Small Penis (micropenis)
- Suggests low Androgen level or Growth Hormone
- Normal penis length: 2.5 cm to 4.2 cm
- Normal penis diameter: 0.9 to 1.3 cm
-
Ambiguous Genitalia signs (requires urgent urology/endocrine/Genetics consult prior to gender assignment)
- Bilateral Undescended Testes
- Micropenis
- Bifid Scrotum