A Newborn Girl with Unusual Genitalia.

Anewborn female infant presented to the outpatient pediatric office for an initial weight visit on her third day of life. She was born full term, appropriate for gestational age, via spontaneous vaginal delivery to a 21-year-old mother. The mother was blood type A+, HIV negative, rubella immune, hepatitis B surface antigen negative, rapid plasma reagin nonreactive, and Group B streptococcus positive. The mother received antepartum antibiotics prior to delivery. The baby’s APGAR scores were 8 at 1 minute and 9 at 5 minutes. The baby did well in the newborn nursery, and had been breast-feeding and voiding and stooling several times per day. It was noted in the nursery that she had an unusual appearance of her labia. On examination, the baby was awake and appropriate for age. She had no dysmorphic features, and her palate was intact. There was no heart murmur. Her abdomen was soft and nontender, with no organomegaly or mass. Her umbilical stump was still attached. Her genitourinary examination revealed normal labia majora. There appeared to be mucosal tissue from the fossa navicularis extending posteriorally through the posterior fourchette ending just anterior to the anal opening. There was no clitoromegaly. There was a sleeve hymen. The anal sphincter surrounded the anal opening normally (Figure 1).