Newborns are special and have very specific characteristics. The passage from the uterus to the outside is a great contrast and they must adapt; therefore, many of their organs will undergo a series of changes after birth. When a baby is born, it is common for parents to wonder if what is happening to them is normal or not; and the subject of genitalia, in particular, raises many doubts .
What is normal for girls
- The genitals can be swollen after birth Both in boys and girls, we can notice that the genitals are swollen. It seems to be due to their own development, to the passage of maternal hormones and as a consequence of childbirth. In the case of girls, it is quite common that the labia majora are swollen at birth, with very smooth skin, and little by little they lose weight.
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Vaginal discharge Although it is very surprising to parents, it is not uncommon for newborn girls to have vaginal discharge, a mucous discharge, the first days of life. It is due to the passage of maternal hormones. We should not take any special care and do not carry out a thorough cleaning (we should not make an effort to make it disappear).
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The first menstruation Although less frequent, some girls may have a “mini-period” in the first days of life also due to the passage of maternal hormones (specifically, estrogens). The breast engorgement that newborns of both sexes can present is also due to them.
What is normal in children
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Cryptorchia or lack of testicular descent . During pregnancy, the testicles form in the abdomen of the fetus and gradually descend towards the groin, reaching the scrotal bag around 35 weeks of pregnancy. Sometimes at the time of birth they are not completely descended and we can notice one or both empty scrotal bags. We are talking about cryptorchidism. In most cases they will end their descent during the first 6 months of life, but it is important that the pediatrician performs a good follow-up.
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When fluid builds up in the testicles . As we have commented, the testicles descend from the abdomen towards the scrotal bag usually before birth. They do this through a tube called the vaginal peritoneum that usually closes (obliterated) when the descent is complete. However, it can sometimes remain open and leak fluid, which collects in the scrotal sac and causes it to swell. It is what is known as a hydrocele . When the hole is larger, intestinal content can also pass and we would be facing an inguinal hernia .
- Phimosis of the newborn . Most newborns are born with phimosis. The orifice of the foreskin, which is the skin that covers the glans of the penis, is narrow in most neonates; in addition, the glans and foreskin appear stuck together by a fine fibrous tissue (balano-preputial adhesions). Both of these circumstances make it difficult to retract the foreskin and visualize the glans. Although in the past it was customary to force the foreskin down in the first visits to the pediatrician, it has been found that throughout the first months and years of life the adhesions will disappear and the hole will widen without our having to intervene. The “pull” or forced retraction of the foreskin not only does not provide any benefit but can be counterproductive, since wounds are made that when healing can cause fibrosis and worsen phimosis.
What is not normal for girls
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We have commented that both vaginal discharge and small bleeding are common in the first days of life due to the passage of maternal hormones. If there is vaginal bleeding later, or excessive mucous secretion and / or vulvovaginal irritation, we should consult.
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Vulvar synechiae are quite frequent although they usually appear somewhat later (more incidence at 3-6 months of life and around 6 years). It is an adhesion of the labia minora that does not reveal the vagina completely. They do not usually cause any discomfort, although if the labia minora are completely fused (what we call total vulvar synechia), difficulties with urination or a foul-smelling vaginal discharge may appear. Many resolve spontaneously so they should not be treated except in the case of complete fusion that causes difficulty in urination or recurrent infections.
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A rare anomaly in the genitalia of girls is the imperforate hymen , which can be detected in the neonatal period or go unnoticed and diagnosed in adolescence. The hymen is the membrane that lines the entrance to the vagina; it usually covers it only partially. If this membrane completely covers the vaginal opening, we speak of an imperforate hymen. This makes vaginal secretions unable to come out. In young girls this can go unnoticed and is detected with the arrival of menstruation.
What is not normal in children
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Although the testicles can descend to the scrotal bag after birth, if both are missing ( bilateral cryptorchidism ) we must perform some complementary test. If only one is missing (unilateral cryptorchidism), the pediatrician will closely monitor it to ensure that it descends and if it does not do so after 6 months (in premature babies it may take a little longer) he will refer you to the infant surgeon as it is likely that they will need to be surgically descended . It is very important that the testicles are located in the scrotal bag, since they need a temperature lower than that of the abdomen to develop their function correctly.
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Hydrocele that appears in the newborn usually resolves spontaneously before one year of life. However, if it persists beyond that, it should be evaluated by a pediatric surgeon and they usually operate around two years of age. If it is an inguinal hernia, it is usually operated on at the time of diagnosis.
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Phimosis is present in the vast majority of newborns but, as we have mentioned, it will resolve as they grow. But if the phimosis persists beyond 3 or 4 years, some treatment should be done. As a first option, a corticosteroid ointment can be applied to help widen the hole in the foreskin. If this doesn’t work, you will need to have surgery later.
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Other malformations that we can find in men are epispadias and hypospadias and are due to an incorrect location of the urethral orifice. In the case of epispadias , which is less common, the urethral orifice is located on the upper side of the penis and in the case of hypospadias on the lower part. These cases must always be operated on.
In Babies and more | The 17 most frequent doubts about the newborn in the first hours of life
