Newborn Genitalia Exam

Breast Buds and Galactorrhea
1. Resolves in first month of life
2. Consult pediatric endocrinology if persistent
Labia
1. Term infant: Labia majora prominent
2. Preterm Infant: Labia minora and Clitoris prominent
Vaginal Skin Tag or hymenal tag
1. Normal and require no treatment
White mucoid discharge or scant Vaginal Bleeding
1. 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)
1. Fused labia
2. Clitoromegaly

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)
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
Inguinal Hernia
1. Complicates Communicating Hydrocele, with bowel passing into Inguinal Canal
2. Risk of incarceration and Strangulation
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)
Chordee
1. Ventral penile curvature
2. Do not circumcise
Buried penis
1. Penis retracts into fat pad
2. Do not circumcise (risk of entrapping glans penis with post-procedure swelling)
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
Ambiguous Genitalia signs (requires urgent urology/endocrine/Genetics consult prior to gender assignment)
1. Bilateral Undescended Testes
2. Micropenis
3. Bifid Scrotum