1. Quality Education for a Healthier Scotland Multidisciplinary Promoting multiprofessional education and development in Scottish maternity care External Genitalia

2. Quality Education for a Healthier Scotland Multidisciplinary Structure of the Examination Boys penis meatus curvature urinary stream scrotum testes Girls vulva clitoris labia discharge Anus

3. Quality Education for a Healthier Scotland Multidisciplinary Boys hernias undescended testis hydrocele pigmentation of the scrotum torsion of the testis penile chordee hypospadias poor urinary stream.

4. Quality Education for a Healthier Scotland Multidisciplinary Girls pigmentation of the labia skin tags vaginal bleeding clitoris urinary meatus.

5. Quality Education for a Healthier Scotland Multidisciplinary Both sexes imperforate anus anteriorly placed anus delayed passage of meconium.

6. Quality Education for a Healthier Scotland Multidisciplinary Hernias Common Reducible Irreducible may strangulate Early referral for paediatric surgery.

7. Quality Education for a Healthier Scotland Multidisciplinary Undescended testis Incidence 2% at birth 1.5 % by 3 months retractile palpable impalpable Referral for surgery age 1-2 years.

8. Quality Education for a Healthier Scotland Multidisciplinary Testicular Descent

9. Quality Education for a Healthier Scotland Multidisciplinary Empty scrotum The hemi-scrotum on the left side is empty and smaller than the right suggesting an ectopic or otherwise mal-descended testis.

10. Quality Education for a Healthier Scotland Multidisciplinary Hydrocele Firm or fluctuant Transilluminate Non tender Most resolve spontaneously.

11. Quality Education for a Healthier Scotland Multidisciplinary Pigmentation Scrotum or labia Common in babies with non-caucasian parents Rare cause would be Congenital Adrenal Hyperplasia in boys.

12. Quality Education for a Healthier Scotland Multidisciplinary Torsion of testis UNCOMMON treatment required within 6 hours for testis to remain viable hard tender testis sometimes bluish discolouration most neonatal cases testis is already necrotic URGENT surgical referral.

13. Quality Education for a Healthier Scotland Multidisciplinary Penis Length The average stretched penile length at birth is about 4 cm 90% of Term boys between 2.4 and 5.5 cm Refer if seems small

14. Quality Education for a Healthier Scotland Multidisciplinary Penis Penile Chordee Tethering of penis Problems with erection Surgical referral Penile length ?part pf syndrome.

15. Quality Education for a Healthier Scotland Multidisciplinary Hypospadias hooded prepuce ventral urethral meatus Chordee Palpate carefully for testes 3 per 1000 Surgical correction < 2 years AVOID CIRCUMCISION.

16. Quality Education for a Healthier Scotland Multidisciplinary Hypospadias

17. Quality Education for a Healthier Scotland Multidisciplinary Girls Skin tags Common No action required Urinary meatus. Clitoris Relatively larger in preterm or IUGR infants.

18. Quality Education for a Healthier Scotland Multidisciplinary Mucosal skin tag A fold or continuation of the mucosa from the vaginal wall is often seen in newborn girls. It shrinks and disappears in the first week.

19. Quality Education for a Healthier Scotland Multidisciplinary Vaginal bleeding Pseudo-menstruation: normal withdrawal of maternal hormones 48 hours to 6 days.

20. Quality Education for a Healthier Scotland Multidisciplinary Anus Imperforate, URGENT referral Anteriorly placed Delayed passage of meconium.

21. Quality Education for a Healthier Scotland Multidisciplinary Ambiguous genitalia Distressing Communication with parents important Delay in assigning sex URGENT referral.

22. Quality Education for a Healthier Scotland Multidisciplinary Questions?

23. Quality Education for a Healthier Scotland Multidisciplinary Summary Boys more than girls. Common problems not usually urgent. Communication with colleagues is key.