Under normal circumstances, a newborn’s genitals not only clearly identify the baby as male or female at the time of birth, but will show very few distinct changes until puberty a number of years later. The baby girl’s genital area—specifically the labia, or lips at the opening of the vagina—may appear swollen. In addition, a little mucus or even a small amount of blood may drain from the vagina during the first few days of life. Both are caused by sudden changes in hormone levels after birth and will disappear within several days without treatment. When the labia are gently spread apart, the hymen, a thin membrane that surrounds the opening of the vagina, will be visible. Occasionally the labia will partially or completely grow together during the first or second year of life. Sometimes ongoing irritation of the labia from diaper rash or detergents will contribute to this condition, which is called labial adhesions. Normally no symptoms are present, but if the labia begin to obstruct the flow of urine, the child will be at risk for urinary tract infection. If you notice that your daughter’s labia appear stuck together, tell her doctor. The physician may, with gentle manipulation, be able to pull them apart. If this cannot be done, a small amount of estrogen cream (obtained by prescription) can be applied to the edges of the labia for several days until they can be separated. Estrogen cream can also be used if adhesions form repeatedly. Eventually, a combination of physical growth and the body’s own internal estrogen production will end this problem.
The scrotum of a newborn baby boy may appear puffy or swollen, a condition that normally resolves within a few days. Usually the testes (or testicles) will have arrived in the scrotum after their short but important journey from within the abdomen to the scrotal sac during the final weeks of pregnancy. If the boy is born in full term (forty weeks), both testes they might move around inside the scrotum and may be felt as high up as the crease at the top of the thigh. This is normal as long as both testes can be felt in the scrotum most of the time.
Basic Care and Hygiene
If your son has not been circumcised, you need only bathe his genitals in soap and water along with the rest of the diaper area. At birth, the foreskin is firmly attached to the penis and cannot be retracted (pulled back). In fact, trying to do so can damage the sensitive tissues underneath. As your son grows, the foreskin will gradually separate from the head of the penis, and eventually it can be retracted. Once this has occurred, parents can begin gently pulling the foreskin back during bathing to clean the end of the penis. As your son grows older, he can do this himself as part of his normal bathing. Do not use swabs to clean beneath a foreskin that will not retract. In one year of age, 50 percent of boys have foreskins that can be pulled back, and by five years of age 90 percent of boys have retractable foreskins.
If your son has been circumcised using a device called a Gomco clamp, a thin dressing such as gauze and some Vaseline will be used to cover the tip of his penis. If the dressing becomes stuck to the penis, it can be soaked off with warm water. The edge of the circumcision may look quite yellow while it is healing. This appearance is sometimes confused with an infection. If you have any questions, call your physician. Many circumcisions are done with a Plastibell, and the baby will leave the hospital with the Plastibell still on his penis. The plastic ring should gradually fall off within a few days. If it does not or if you notice that the skin around it is becoming red, call your baby’s physician.
No special care is needed for the genitals of infant girls. Tub baths, along with routine diaper changes, are sufficient. Occasionally spread her thighs and labia apart to wipe gently in the creases with warm water. Even when you change your baby’s diaper frequently and keep the area clean, diaper rash may still develop. The first thing you might notice is redness or small bumps on the skin covered by the diaper. Usually the skin in the creases or skin folds is not affected. The most common cause of diaper rash is prolonged contact with a wet or soiled diaper, because chemicals in the urine and stool can irritate a baby’s sensitive skin. Babies are more likely to develop diaper rash when they begin sleeping through the night, when they begin eating solid foods (probably due to the increased acids that are excreted), and when they have diarrhea. Other causes of diaper rash include fragrance irritants in baby wipes, detergents to wash diapers, or soaps used during bathing. Some babies will even react to the material used in a specific type of disposable diaper. Sometimes rashes are there due to a yeast infection (Candida). Yeast infections tend to cause a more intense irritation, often with small extensions or satellites on the edges of the rash.
Several measures can help prevent or heal diaper rash:
- Change the diaper as soon as possible after it becomes wet or soiled. Once a rash develops, ongoing contact with urine and stool can irritate it further.
- Try to eliminate other types of irritants. Change to fragrance and alcohol-free wipes. If you wash your own cloth diapers, use soap rather than detergent, and double-rinse. If using disposable diapers, try another brand.
- Let your baby’s bottom air dry after it is cleaned. Leave it open to the air for a while before putting on a new diaper.
- Ointments such as Desitin or A&D can have a soothing effect. If the rash is severe, your baby’s doctor may prescribe a mild cortisone cream to use for a few days. If yeast appears to be involved, an anti-fungal cream, either alone or blended with cortisone, will usually calm the rash within a few days. Infections involving the genital area occur less preeminently among older children. Uncircumcised boys occasionally develop an infection under the foreskin, manifested by local pain, swelling, and discharge. This should be evaluated and treated by a physician. Irritation at the tip of the urethra, the small tube through which urine passes, can also be a bath time related problem in boys.
Prepubertal girls sometimes develop irritation of external genitalia (vulva), most commonly caused by prolonged exposure to bubble bath, soap, or shampoo in bathwater. Some simple preventive maneuvers include the following:
- Avoid bubble baths altogether.
- Keep bath times relatively short, 15 minutes or less.
- If a child wants to play in the bath, let her do so before any soap or shampoo enters the water. As soon as the cleansing and hair washing is done, get her out.
If a prepubertal girl develops a distinct vaginal discharge, she should be seen by her physician. Occasionally during self-exploration a toddler or preschooler will insert a small object (such as a bead or a small wad of tissue) into her own vagina (or a child may insert an object into another child’s vagina). This will cause a bacterial infection if not removed, but attempts to do so should not be made at home. Bacterial infections may also occur without a foreign object present. The doctor may collect a small amount of discharge on a sterile cotton swab to do a culture to identify the organism. Vaginal yeast infection is not typically seen before puberty. Using a nonprescription vaginal yeast remedy is not an appropriate substitute for a medical evaluation when a vaginal discharge is present in a prepubertal girl.
Among adolescents who have had intercourse even once, any unusual discharge from the vagina or penis must be evaluated for sexually transmitted disease.