Abstract Inspect the genitalia. The mother of the patient or another woman should be in the room when you perform a vaginal examination. Ask the mother to pull the pants or undergarments below the knee while a blanket covers the patient. Always wear gloves. Answer succinctly any questions the patient raises. Inspect pubic hair, mons pubis, labia majora, labia minora, clitoris, urethral meatus, and vaginal introitus for presence, location, infestations, appearance, and discharge. A large clitoris (a glans wider than 10 mm) may be normal or an isolated physical finding; however, it may indicate adrenal hyperplasia or any of the conditions associated with precocious puberty defined as occurring before age 8 years (7 years in African Americans) in girls. The clitoris may not develop in adolescent girls with hypopituitarism or gonadal dysgenesis. The external genitalia grow very little until adolescence starts. In early puberty, a rectal examination and an examination with the girl on the examining table with the knees bent and the soles of the feet flat allows the patient to hold the labia apart when this exam is indicated. Show the equipment to be used and explain any expected pain or pressure. Pubic hair stages (Figure 15.1) are useful in quantifying development. Urethral discharges are always pathologic in childhood and may indicate infection anywhere in the urinary tract. A flaming red area around the end of the urethra may be caused by prolapse of the urethral mucosa. An eccentric mass near the urethra may be a cyst, urethral polyp, papilloma, caruncle, condyloma, sarcoma botryoides, prolapsed ureterocele, or periurethral abscess.