Figure 1.

(a) Ultrasound scan, 2D and 3D, of the fetal genitalia done in the second trimester. Visualization of the vulva, clitoris, and labia is considered to indicate a female fetus whereas demonstration of the scrotum, penis, descended testicles, and penile midline raphe is interpreted as indicative of a male. In the ultrasound image, there is a labial/scrotum-like formation (blue arrow) and a median prominence similar to the phallus/clitoris (red arrow). (b) Infant 24 h after birth with ambiguous genitalia. The phallus was 1.4 cm in length with a blind dimple on the glans and a urethra that opened ventrally at the base, consistent with Prader 4 hypospadias. The clitoral index was 0.7. The anogenital ratio was 0.78. No gonads were palpable in the labial/scrotal tissue. Pelvic imaging did not identify a uterus or ovary, but only small formations in the inguinal duct.