Newborn Period And Infancy

In the newborn female, the genitalia will be prominent due to the effects of maternal estrogen. The labia majora and minora have a dull pink color in light-skinned infants and may be hyperpigmented in dark-skinned infants. During the first few weeks of life, there is often a milky white discharge that may be blood-tinged. This estrogenized appearance of the genitalia decreases during the first year of life.

Examine the female genitalia with the infant in the supine position. One of the challenges is to determine the actual anatomy of the female infant's genitalia, which is shown below.

Ambiguous genitalia, involving mas-culinization of the female external genitalia, is a rare condition caused by endocrine disorders such as congenital adrenal hyperplasia (see Table 17-18, Abnormalities of the Female Genitourinary System, p. 777).

Urethral meatus

Para-urethral duct orifice (skene)

Greater vestibular glands of Bartholin

Urethral meatus

Para-urethral duct orifice (skene)

Greater vestibular glands of Bartholin

Prepuce

Clitoris Labia majora

Labia minora Hymenal membrane

Hymenal orifice (introitus)

Fossa navicularis (vestibular fossa)

Posterior fourchette (frenulum of labia)

Anterior commissure

Prepuce

Clitoris Labia majora

Labia minora Hymenal membrane

Hymenal orifice (introitus)

Fossa navicularis (vestibular fossa)

Posterior fourchette (frenulum of labia)

Examine the different structures systematically, including the size of the clitoris, the color and size of the labia majora, and the presence of rashes, bruises, or external lesions. Next, separate the labia majora at their midpoint with the thumb of each hand for young infants, or as shown in the diagrams on p. 710 for early and late childhood. Infants will not mind the examination as they are used to having their diapers changed and their bodies washed.

Inspect the urethral orifice and the labia minora. Assess the hymen, which in newborns and young infants is a thickened, avascular structure with a central orifice, covering the vaginal opening. You should be able to note a vaginal opening, although the hymen will be thickened and redundant. Note any discharge.

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100 Pregnancy Tips

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