Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Gynecologic examination of the newborn and child

Marc R Laufer, MD
S Jean Emans, MD
Section Editors
Leonard E Weisman, MD
Teresa K Duryea, MD
Deputy Editor
Mary M Torchia, MD


Gynecologic evaluation of the prepubertal child is approached by directing attention to the specific complaint or question to be answered [1]. Educating the child and her family prior to this examination is important both for their reassurance and for gaining their trust. Inspection of the genital region should follow a focused general examination. Knowledge of normal prepubertal anatomy and use of accurate nomenclature are essential for describing and documenting anatomic findings (figure 1).

Gynecologic examination of newborns and children will be reviewed here. Evaluation of common vulvovaginal complaints in these patients is discussed separately. (See "Overview of vulvovaginal complaints in the prepubertal child".)


Examination of external genitalia is a normal part of the routine physical examination. This examination is discussed in detail elsewhere. (See "The pediatric physical examination: The perineum", section on 'Genitourinary system'.)

Assessment of the vulva, hymen, and vagina for signs of vaginal discharge is performed visually without the use of instruments. Visualization of the vagina, which is internal to the hymenal ring, in children typically requires instruments. It is performed under anesthesia for genitourinary complaints that cannot be addressed with external evaluation or in situations of suspected genitourinary pathology. These may include vaginal bleeding, persistent discharge, trauma, cystic or solid masses, suspected congenital anomalies, or acute sexual abuse with a penetrating injury.


General guidelines — The medical history is obtained from both the child, if possible, and her parent(s) or legal guardian. Prior to the examination, she should be told the reason for the office evaluation. A prior traumatic incident or examination can cause girls to become apprehensive and uncooperative. The provider should explain why examination of this area is needed and how the examination will be performed, including whether swabs or lights will be used. Allowing her to maintain some control of the environment is also important. As an example, she can be offered the opportunity to select the gown that she will wear and to view the light source (otoscope, magnifying glass, or direct light).

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Feb 24, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Emans SJ. Office evaluation of the child and adolescent. In: Emans, Laufer, Goldstein's Pediatric & Adolescent Gynecology, 6th, Emans SJ, Laufer MR (Eds), Lippincott Williams & Wilkins, Philadelphia 2012. p.1.
  2. Berenson A, Heger A, Andrews S. Appearance of the hymen in newborns. Pediatrics 1991; 87:458.
  3. Berenson AB, Heger AH, Hayes JM, et al. Appearance of the hymen in prepubertal girls. Pediatrics 1992; 89:387.
  4. McCann J, Voris J, Simon M, Wells R. Perianal findings in prepubertal children selected for nonabuse: a descriptive study. Child Abuse Negl 1989; 13:179.
  5. Adams JA, Kellogg ND, Farst KJ, et al. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. J Pediatr Adolesc Gynecol 2016; 29:81.
  6. McCann J, Wells R, Simon M, Voris J. Genital findings in prepubertal girls selected for nonabuse: a descriptive study. Pediatrics 1990; 86:428.
  7. Jenny C, Kuhns ML, Arakawa F. Hymens in newborn female infants. Pediatrics 1987; 80:399.
  8. Girardet RG, Lahoti S, Howard LA, et al. Epidemiology of sexually transmitted infections in suspected child victims of sexual assault. Pediatrics 2009; 124:79.
  9. Black CM, Driebe EM, Howard LA, et al. Multicenter study of nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in children being evaluated for sexual abuse. Pediatr Infect Dis J 2009; 28:608.
  10. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.