Genitalia and Anus

The genitalia of the female child should have a visibly patent vaginal orifice, with the labia majora covering the labia minora, clitoris, and vaginal opening. The labia majora should be completely separate from each other (ensuring the absence of labioscrotal fusion). The labia majora should be palpated to evaluate the presence of inguinal hernia or ectopic gonads.

The male infant should have two palpable testicles of similar size within the scrotum. If the infant is cold during the examination, the testicles may be retracted and might even be found at the distal end of the inguinal canal. Each testicle, however, should be able to be easily brought down into the scrotum. The testicles should be similar in size and shape, although presence of significant hydrocele is a common transient finding in newborns. A hydrocele should transil-luminate, and any testicular mass that does not transillumi-nate should be further evaluated.

The glans of the penis is normally covered completely by foreskin, and the urethral meatus should be located at the tip of the glans. A child with the urethral meatus opening on the ventral (hypospadias) or dorsal (epispadias) surface of the penis should not be circumcised until pediatric urologic consultation has been completed.

Most male and female infants urinate within the first 24 hours of life. Delay in urination should prompt an evaluation of the kidneys, bladder and urethra (Tappero and Honeyfield, 2003).

The anus should be inspected for patency during the initial examination, and the infant should pass stool within the first 24 hours of life. The first several bowel movements are meco-nium stools, dark and black with a tarry consistency. These eventually change to the thin, yellowish stools of the newborn.

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