Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Submit Manuscript
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Topic/Program Collections
    • Blog
  • Multimedia
    • Teaching Slides
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • Log out
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • Log out
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Submit Manuscript
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Topic/Program Collections
    • Blog
  • Multimedia
    • Teaching Slides
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
American Academy of Pediatrics
Online

Visual Diagnosis: Newborn With a Perineal Lesion

Lisa Hunt and Ganga Srinivas
Pediatrics in Review January 2016, 37 (1) e1-e3; DOI: https://doi.org/10.1542/pir.2015-0043
Lisa Hunt
*Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ganga Srinivas
*Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Comments
Loading
Download PDF
  1. Lisa Hunt, MD*
  2. Ganga Srinivas, MBBS, FAAP*
  1. *Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
  • AUTHOR DISCLOSURE

    Dr Hunt has disclosed no financial relationships relevant to this article. Dr Srinivas has disclosed he is a consultant for Novartis, Alexion Pharmaceuticals, Inc, Boeringer Ingelheim, and ACI Clinical. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

Examination of a dizygotic-dichorionic twin girl in the newborn nursery reveals a perineal sulcus. She was born at 38 weeks and 2 days gestation via cesarean section without instrumentation to a 30-year-old mother whose pregnancy was uncomplicated except for a positive Group B Streptococcus culture at 36 weeks’ gestation. The mother received incomplete intrapartum antibiotic prophylaxis during labor. Delivery was complicated by failure to progress during the first stage of labor, necessitating cesarean section. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The mother took prenatal vitamins and promethazine during pregnancy. She denied tobacco, alcohol, and illegal drug use during pregnancy. The delivery room course was benign, and no abnormalities were noted in the delivery room examination.

The newborn appears appropriate for gestational age, with a birthweight of 3.55 kg (60th percentile), length of 47 cm (13th percentile), and head circumference of 34 cm (54th percentile). Initial evaluation of the perineum reveals a thickened appearance to the median raphe (Fig. 1). More thorough examination of the perineum with the infant’s legs flexed on the abdomen reveals a wet mucosal sulcus extending the length of the perineum from the posterior vaginal fourchette to the anterior anal verge (Fig. 2). The anal mucosa, caliber, and tone are normal. The anal wink is intact. The anus is in the appropriate position, and the infant has had witnessed normal stooling. Vaginal and urethral openings are normal in appearance and location. The spine is normal, with no obvious sacral abnormalities. She demonstrates normal neurologic function, including a plantar response with bilateral upgoing toes (positive Babinski sign), plantar grasp, and stepping reflexes. No other anatomic abnormalities are evident.

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Thickened appearance to the median raphe.

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

Wet mucosal sulcus extending the length of the perineum from the posterior vaginal fourchette to the anterior anal verge.

The diagnosis is established based on the clinical examination. The pediatric surgery consultant agrees with the diagnosis and recommends no further intervention.

Diagnosis

The patient has a perineal groove, a rare congenital abnormality of uncertain pathogenesis.

Discussion

Perineal groove is a rarely described congenital anomaly that is generally defined as a wet sulcus extending from the posterior fourchette of the vagina to the anterior anus. The “wet” appearance is due to the sulcus typically being lined with a mucous membrane. The incidence of perineal grooves is unclear because this anomaly is likely underrecognized and reported. In this patient, the defect was only visible when the thighs were fully flexed onto the abdomen (the diaper changing position). The anomaly is predominantly found in females; one case of a perineal groove in a male has been reported. The underlying pathogenesis remains unclear, although several hypotheses about the embryologic origin of the anomaly have been proposed. Hypotheses include incomplete fusion of the perineal raphe, incomplete fusion of the median genital folds, a remnant of an open cloacal duct, or a defect in the uroanal septum.

Conservative management is generally preferred for perineal grooves. The anomaly usually self-resolves, with epithelialization by 1 year of age. Surgical intervention is rarely indicated unless performed for cosmetic purposes. Complications requiring surgery are rare and include skin infections and persistent mucus drainage. If surgical intervention is indicated, it is typically performed after 2 years of age to allow for potential self-resolution. Screening for associated anomalies is not warranted because a perineal groove typically is an isolated finding. Only three cases of coexisting congenital anomalies have been described: hypospadias with bifid scrotum, ectopic anus, and an unspecified urinary tract anomaly.

Recognizing this anomaly is important because perineal grooves can be confused with other diagnoses, such as irritant dermatitis, hemangiomas, infection, lichen sclerosis, and sexual abuse. Identification of a perineal groove as a mild congenital abnormality can avoid unnecessary procedures and interventions.

Patient Course

No surgical intervention was required for the patient. No complications of the perineal groove arose. At her 6-month health maintenance visit, the perineal groove had fully epithelialized. She is growing and developing normally.

Summary

  • Perineal groove is described as a wet sulcus lined with mucous membrane extending from the posterior fourchette to the anterior anus.

  • Perineal grooves are rarely described in literature but are likely more common in practice.

  • The underlying pathogenesis and embryologic origin of perineal grooves are poorly understood.

  • Perineal grooves generally self-resolve by 1 year of age.

  • Surgical intervention is rarely indicated but can be considered for rare complications (infections, mucus drainage) or for cosmetic purposes, usually after 2 years of age.

  • Recognition of this mild anomaly can eliminate unnecessary (and potentially invasive) testing and procedures.

Suggested Readings

    1. Chatterjee SK,
    2. Chatterjee US,
    3. Chatterjee U
    . Perineal groove with penoscrotal hypospadias. Pediatr Surg Int. 2003;19(7):554–556
    OpenUrlCrossRefPubMed
    1. Diaz L,
    2. Levy ML,
    3. Kalajian A,
    4. Metry D
    . Perineal groove: a report of 2 cases. JAMA Dermatol. 2014;150(1):101–102
    OpenUrlCrossRefPubMed
    1. Esposito C,
    2. Giurin I,
    3. Savanelli A,
    4. Alicchio F,
    5. Settimi A
    . Current trends in the management of pediatric patients with perineal groove. J Pediatr Adolesc Gynecol. 2011;24(5):263–265
    OpenUrlCrossRefPubMed
    1. Mullassery D,
    2. Turnock R,
    3. Kokai G
    . Perineal groove. J Pediatr Surg. 2006;41(3):e41–e43
    OpenUrlPubMed
    1. Sekaran P,
    2. Shawis R
    . Perineal groove: A rare congenital abnormality of failure of fusion of the perineal raphe and discussion of its embryological origin. Clin Anat. 2009;22(7):823–825
    OpenUrlCrossRefPubMed
  • © American Academy of Pediatrics, 2016. All rights reserved.
PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Pediatrics in Review: 37 (1)
Pediatrics in Review
Vol. 37, Issue 1
1 Jan 2016
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
  • Complete Issue (PDF)
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Visual Diagnosis: Newborn With a Perineal Lesion
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Visual Diagnosis: Newborn With a Perineal Lesion
Lisa Hunt, Ganga Srinivas
Pediatrics in Review Jan 2016, 37 (1) e1-e3; DOI: 10.1542/pir.2015-0043

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Visual Diagnosis: Newborn With a Perineal Lesion
Lisa Hunt, Ganga Srinivas
Pediatrics in Review Jan 2016, 37 (1) e1-e3; DOI: 10.1542/pir.2015-0043
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Presentation
    • Diagnosis
    • Suggested Readings
  • Figures & Data
  • Info & Metrics
  • Comments

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • A Neonate With a Perineal Lesion
  • The Role of Integrated Care in a Medical Home for Patients With a Fetal Alcohol Spectrum Disorder
  • Google Scholar

More in this TOC Section

  • Visual Diagnosis: Petechiae, Gingival Hyperplasia, Metaphyseal Lucencies, and Refusal to Ambulate in a 5-year-old Boy
  • Visual Diagnosis: Tension Pneumothorax with Evolving Cysts in an Infant
  • Visual Diagnosis: Rapid Deterioration of Respiratory Status and Lower Limb Hypotonia in a 6-month-old Infant
Show more Online

Similar Articles

  • Journal Info
  • Editorial Board
  • ABP Content Specifications Map
  • Overview
  • Licensing Information
  • Authors
  • Author Guidelines
  • Submit My Manuscript
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • AAP.org
  • shopAAP
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
American Academy of Pediatrics

© 2021 American Academy of Pediatrics