How to understand the sex of the baby from the ultrasound: the guide of the midwife

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How to understand the sex of the baby from the ultrasound

It is a very fascinating topic for expectant mothers to look at the images on the monitor or on the ultrasound CD and say: but where can I understand, how do they see? whether it is male or female? In this article I would like to try to answer all these questions by also giving suggestions on where and how to look at an ultrasound.

In this article

  • Morphological ultrasound
  • Differences in ultrasound between male and female
  • How to tell if it is male or female
  • How can I tell by looking at the ultrasound if it is male or female

Morphological ultrasound

First of all I would like to emphasize that it is true, morphological ultrasound it is the moment in which sex is mostly clear but know that it is possible that you see it even some time before or that you do not see because the child is from behind and has no intention of being seen. In any case, through this ultrasound (performed between 19 and 21-22 weeks of gestation) is studied in depth the whole anatomy, the morphology of the child from head to toe. It is a very important moment, the moment in which anomalies can be detected, if any, and to verify that, after the first quarter, everything is proceeding as it should. It is a very exciting moment because for the first time you will see your baby with clearly human features and you will be able to observe every detail of him. Ask and let yourself clarify any doubts, any curiosity and let them explain what they are observing because it is really a special moment.

Read also: How to read ultrasound in pregnancy

Differences in ultrasound between male and female

When we talk about fetuses we must necessarily think that there are no extreme differences between males and females. Let me explain better, it is not possible to determine whether the child will be male or female by looking only at the size, length, head circumference, etc. these are parameters that also depend on other factors (such as the proportions of the parents) and therefore are not indicative. We must therefore necessarily focus on those factors that can help us understand, beyond the vision of the genitals if we are in front of a baby or a girl.

  • Unique apparatus which is different is that genitourinary. In fact, looking not so much at the genitals as at the urinary system, we can see that boys have a slightly longer urethra than girls.
  • By displaying the lower abdomen it will also be possible to notice the presence of two small masses, one on each side. In fact, from the 15th week of gestation the production of very high testosterone causes the differentiation of the tissues and the appearance of the testicles. This does not happen in girls, for whom the ovaries will be empty rounded masses or with some small, smaller dot: the follicles that will give rise to the eggs.
  • It is evident that the visualization of the male genital organs however, they are the fundamental deterrent. In fact, seeing the penis is what makes us say ok it is a male, the absence of him instead makes us assume that it is a female.

How to tell if it is male or female

Obviously, the distinction between male and female does not end with the visualization of the penis. The basic reason is that as I said before, sometimes they do not show themselves, they do not open their legs and not even by rotating the ultrasound probe we are able to position ourselves in order to actually understand sex. There is another aspect that should not be underestimated in the differentiation between male and female: sometimes the clitoris in girls is swollen, very protruding and can be mistaken for a penis (especially if the vision is not so clear due to the position of the child). The fact that you can clearly see the female external genitalia it not only helps to identify the sex but also to exclude those that are specific chromosomal pathologies linked to sex (especially in the presence of a family history) or ovarian pathologies such as cysts which unfortunately can occur, albeit in rare cases, in the fetal period.

The visualization of the testicles in the abdominal area can help us to understand sex, and as we have said previously they are positioned in the abdomen, in the area of ​​the kidneys where their maturation takes place very quickly. They will begin their descent path to their final location after week 28. Why in the abdomen? Like the ovaries, the testicles are a very important site for male fertility because it is the place where sperm are produced, fed and sent.

This process is very delicate, it needs constant temperatures especially in the part where the baby's immature cells must first become mature and able to function and then move to their adult location.

How can I tell by looking at the ultrasound if it is male or female

We then get to the heart of the matter, the problem that is dear to all mothers, that is "but looking at that image, how do I understand if it is a boy or a girl?" Well, here are some tricks to help you observe and read an ultrasound image.

  1. First check which part of the body you are looking at, photos are usually taken from head to toe in various sections and positions, and at the top the words: head, abdomen, kidneys etc. are indicated, so that even your doctor who is not performing the ultrasound can understand what actually look. 
  2. Once you see the word abdomen and kidneys look at the kind of shape that the dark border of the image has, this tells you what perspective are we using to look at the image although modern ultrasound scanners also have the indication "front view, longitudinal view". There is no doubt that a frontal view in our case is not the best, because it is as if you were looking at it in the face and it is not always clear. Better a longitudinal view.
  3. After the photo of the kidneys, you usually find the photo of the genital system, and normally looks like this: outline of various shades of gray, a sort of black hole inside which there is another gray part. We are seeing the baby as if you are looking at it from below and it is the best position for determining the type of genitals. You will see a kind of "U" shape formed by the baby's pelvis and legs which can be more or less wide. You need to focus on the area where the U makes the curve. Those are the genitals.
  4. Normally a male genital differs from a female one because it has two small balls surmounted by a conical, triangular but not regular structure, a sort of hat. That's the penis. In girls, even in the case of hypertrophic and swollen clitoris, the size is much smaller than that of the penis, which you will certainly notice. Let's say to give you indications of measurement that in the case of a boy this "hat" can measure even 4-5mm while in girls if it is present it is very small 1-2mm at most. Here you have now recognized the sex of the baby.

At the end of this topic, however, I would like to reiterate a couple of concepts.

  • The first is that surely the identification of sex is a very very important thing but if it does not happen in the morphology, nothing happens, from month to month we will try to go and study the area and verify it.
  • The second concept is that there is a lot of experience, the dexterity of those who do the ultrasound and the type of instrument they use. A very experienced sonographer will be able to identify and explain every hidden feature of your child regardless of the type of ultrasound used.
  • Furthermore, the more the ultrasound system is new, the higher the quality of the images, the sharpness and the accuracy, thanks to the advances that are continually made in the imaging techniques of which ultrasound is part. So concluding, it is important to perform morphological ultrasound to study the anatomy of the child and therefore also the sex determination. But I also find it very funny and very nice to be able to guess, imagine, play about her sex. It is therefore not at all necessary, if you do not want to know, to be told the sex. Just tell the doctor that you want the surprise and you will be satisfied because this is still one of the cases where a little surprise could make pregnancy a special moment to remember for a lifetime.
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