Necessary at every well visit. Can you assume it’s normal? Who is checking if not you?
Newborns: Note: The first few days of life babies may have orange/red substance in diaper, this is not blood, it’s uric acid crystals. However, baby girls can briefly menstruate after the letdown of mom’s hormones.
Males: A complete exam includes: 1. Tanner stage 2. Location of testicles 3. Circumcision or not. Most often you will not be able to retract the foreskin to determine the location of the urethral meatus, however keep hypospadias in mind. FYI, Stretched penile length of full term male ranges between roughly 3-4.5cm. Testicular length: 1.5-2cm
Hydroceles will transilluminate, and resolve by 12-18 months. Hernias are more rare, do not transilluminate, and may extend into the inguinal canal.
Tanner Staging is assessing: 1. Penile length, 2. testicular size and 3. pubic hair development.
Tanner I: prepubertal
Tanner II: What is the first sign? Gonadarche: testicular volume reaches 4mL/2.5cm. Also: Penile enlargement. Sparse pubic hair, enlargement of scrotum. Age 9-14 years, average 11-12 years.
Tanner III: Peak height velocity.
Tanner IV: Similar to menarche in girls, Spermarche!
Note: 1/3 of boys at 13y of age will undergo gynecomastia, persists for 6-18 months, normal as long as remainder of physical is normal.
Females: Part the Waters!
Retract the vulva to visualize the clitoris and vaginal introitus. You want to make sure they have a normal sized clitoris, patent vagina, no discharges or lesions.
Tanner 1: Many baby girls have skin tags around their vaginal opening, they are a normal variant and go away over time.
Tanner 2: First sign of puberty in girls is breast development, then pubic hair.
Note: Menarche occurs about 2 years after thelarche (Tanner 2 breasts) in caucasian females, about 3 years later in African Americans
Between tanner stages 2-3 breast development, peak height velocity.
ANATOMY:
The vulva encompasses the external female genitalia: the labia, clitoris, urethra and vaginal introitus.
Pubic Hair Development Tanner Staging in girls and boys are the same: Tanner 1: no hair. Tanner 2: Downy hair. Tanner 3: Scant terminal hair. Tanner 4: Terminal hair that fills the entire triangle overlying the pubic region. Stage 5: Beyond the inguinal crease onto the thigh. (NIH)
Precocious puberty = Tanner 2 before age 8y in females or before 9y in males
Delayed puberty = NO Tanner 2 thelarche in females by age 13y, no Tanner 2 gonadarche by age 14y
