Neonatology Book

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Newborn Genitalia Exam

Aka: Newborn Genitalia Exam, Genitourinary Examination in Infants
  1. See Also
    1. Circumcision
  2. Exam: Female
    1. Breast Buds and Galactorrhea
      1. Resolves in first month of life
      2. Consult pediatric endocrinology if persistent
    2. Labia
      1. Term infant: Labia majora prominent
      2. Preterm Infant: Labia minora and Clitoris prominent
    3. Vaginal Skin Tag or hymenal tag
      1. Normal and require no treatment
    4. White mucoid discharge or scant Vaginal Bleeding
      1. Normal withdrawal from maternal Estrogen in first 3-7 days of life
    5. Ambiguous Genitalia signs (requires urgent urology/endocrine/Genetics consult prior to gender assignment)
      1. Fused labia
      2. Clitoromegaly
  3. Exam: Male
    1. Undescended Testes (Cryptorchidism)
      1. More common in Premature Infants
      2. Retractile Testes that can be milked into Scrotum do not require additional evaluation (only routine follow-up)
    2. Communicating Hydrocele
      1. Processus vaginalis fails to close allowing free passage of peritoneal fluid into Scrotum
      2. Typically resolves spontaneously within first 1-2 years of life
    3. Inguinal Hernia
      1. Complicates Communicating Hydrocele, with bowel passing into Inguinal Canal
      2. Risk of incarceration and Strangulation
    4. Hypospadias (with or without Chordee)
      1. Abnormal ventral placement of the Urethral opening (at the glans, shaft or Scrotum)
      2. Do not circumcise (foreskin needed for repair)
      3. Prepuce may adhere to glans (do not retract)
    5. Chordee
      1. Ventral penile curvature
      2. Do not circumcise
    6. Buried penis
      1. Penis retracts into fat pad
      2. Do not circumcise (risk of entrapping glans penis with post-procedure swelling)
    7. Small Penis (micropenis)
      1. Suggests low Androgen level or Growth Hormone
      2. Normal penis length: 2.5 cm to 4.2 cm
      3. Normal penis diameter: 0.9 to 1.3 cm
    8. Ambiguous Genitalia signs (requires urgent urology/endocrine/Genetics consult prior to gender assignment)
      1. Bilateral Undescended Testes
      2. Micropenis
      3. Bifid Scrotum
  4. References
    1. Fuloria (2002) Am Fam Physician 65(2):265-70 [PubMed]
    2. Lewis (2014) Am Fam Physician 90(5): 297-302 [PubMed]

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