The pediatric physical examination: The perineum
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
Examination of the perineum in children will be reviewed here. Other aspects of the pediatric physical examination are discussed separately. (See "The pediatric physical examination: General principles and standard measurements" and "The pediatric physical examination: HEENT" and "The pediatric physical examination: Back, extremities, nervous system, skin, and lymph nodes" and "The pediatric physical examination: Chest and abdomen".)
The examination of an infant, toddler, or child should be performed in the presence of a parent or guardian; if the parent's presence may interfere with the examination (eg, suspected child abuse) a chaperone should be present . The use of a chaperone for the examination of the anorectal and genital areas of adolescent patients should be a shared decision between the patient and the clinician after the clinician has explained the reason for the examination and described how the examination will proceed. The sex of the chaperone should be determined by the patient's wishes and comfort (if possible). If a patient is offered the use of a chaperone and declines, this should be documented in the chart.
The physical findings and approach to examination of the genitourinary system depend upon the age and sex of the patient.
Neonates — The neonatal examination should focus upon congenital anomalies. Attention should be paid to penile length (figure 1), foreskin anatomy, location of the urethral meatus, scrotal anatomy (including rugae), the presence and location of the testes (picture 1), and the presence of abnormal scrotal or inguinal masses. The precipitation of uric acid crystals in the diaper (secondary to increased urinary uric acid excretion in infants) may be misidentified as blood (picture 2).
The tightly adherent foreskin should be gently retracted to reveal the urethral meatus in its normal anatomic position at the tip of the glans penis. Forceful retraction is never indicated, particularly in the infant. Care of the uncircumcised penis is discussed separately. (See "Care of the uncircumcised penis", section on 'Routine care and hygiene'.)
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