Genitourinary Assessment – Physical Examination of the Newborn (Nursing)

00:01 Next, let's talk about genitalia.

00:03 We're going to talk both about female genitalia and male genitalia, and how it might look different depending on gestation and a few other things.

00:12 First, let's look at female genitalia.

00:15 What do you notice right off about this picture? Do you see the edema around the labia majora? This is happening under the influence of estrogen.

00:24 So just like the estrogen cause the increase in edema and around the breast tissue, the same thing will happen with the labia majora and that's what you're seeing here.

00:34 So as the estrogen clears the system of this baby, the labia will go down in size.

00:39 We absolutely want to make sure that the parents know that.

00:44 Let's look at the genitalia of a premature baby.

00:47 So in this picture, what you notice is that the labia minora are prominent and present.

00:53 In the previous picture, the labia minora were hidden by the labia majora.

00:58 In this picture, we can see it without any manipulation whatsoever.

01:02 Now as this baby grows and gets older, the labia majora will eventually cover the labia minora.

01:08 But this is definitely something that you'll notice on most preemie babies that have female genitalia.

01:16 Now remember, we talked about the case of cheese, vernix caseosa.

01:20 Do you see all of that vernix that's located around the labia? Remember, anywhere we have folds is a great spot for the caseosa, vernix case of cheese to collect.

01:34 The other thing I want to talk to you about which is really important to talk to parents about that have female babies is this concept of pseudomenses.

01:42 So remember, estrogen is kind of a theme that's been going through caused engorgement of our breast tissue it caused engorgement of our labile tissue.

01:51 Well, because the baby has a uterus and because there's estrogen, that withdrawal of hormones will still activate the menses, just like it would for any pubescent child or adult or anyone else.

02:05 So when we withdraw that hormone, we get a pseudomenses and the parents may notice that in the diaper.

02:12 So you can see in this particular diaper, there's a little bit of blood here.

02:16 And sometimes it may be even more than this.

02:18 But this is one of those cases where anticipatory guidance is super important, because otherwise this could be very scary to parents.

02:26 So this is pseudomenses.

02:27 And this will only occur once and a few days after they go home.

02:32 So usually we don't get this in the hospital.

02:34 Unfortunately, when we can talk to them about it.

02:36 This is why we want to tell them about it before they go home.

02:40 Now, let's look at the male genitalia.

02:42 There are several assessments that we need to make with the male genitalia to make sure that everything is developed normally.

02:49 One of the first things you may notice is whether the baby had a circumcision or not.

02:54 And whether they've had a circumcision or not, one of the things the nurse needs to check for is the location of the urethral meatus the opening, where the urine comes out.

03:04 We want to make sure that that location is at the very tip of the penis and that it's not on the dorsal or ventral side of the penis, which would be an abnormal location that may require surgical intervention in order to correct.

03:16 We also want to palpate the scrotal sac and make sure that the testes have descended.

03:22 Sometimes when you have a baby that's premature, having undescended testes might be unexpected finding.

03:29 Either way, during an assessment if two testes are not palpated, then this should be reported to the provider.

03:37 And finally, making sure in terms of the scrotum that we look for any signs of discoloration or look for any masses such as a hydrocele.

03:46 These are all abnormalities that need to be discussed with a provider.