Ultrasonography (US) forms the mainstay of imaging in neonates for most abdominal and pelvic pathology. It is particularly suitable for imaging of the reproductive organs for many reasons, the foremost being small and superficial organs that are easily identified on US. Further, there is also the possibility of dynamic evaluation, which is important in babies with conditions such as retractile testis and its differentiation from truly undescended testis. In addition, it also allows for Doppler evaluation, which is also valuable in suspected torsion and differentiation of mass lesions. The advent of transperineal sonography has allowed the evaluation of anomalies of the lower genitalia including the urethra and vagina, as well as fistulae and common channels in children with ambiguous genitalia. This chapter will discuss the technique of genital sonography in neonates, normal imaging appearance as well as common pathology that may be encountered in this age group.