Editing Disorders of Sexual Differentiation (section)

==== History and Physical exam ====
*'''History'''
**'''Family history of'''
**#'''Infant death within the family might suggest the possibility of CAH'''
**#Infertility, amenorrhea, or hirsutism might also suggest possible familial patterns of intersex states
**'''Maternal use of medications, in particular steroids or contraceptives, during the pregnancy'''
*'''Physical exam'''
**'''The critical component is the presence of one or two palpable gonads. This finding effectively rules out over-masculinization [i.e. CAH] of the female.''' 
*** Because ovaries do not descend, a distinctly palpable gonad along the pathway of descent is highly suggestive of a testis.
*** '''The patient with bilateral impalpable testes or a unilateral impalpable testis and hypospadias should be regarded as having a DSD until proven otherwise, whether or not the genitalia appear ambiguous'''
****Incidence of DSD with
*****Unilateral undescended testis: 30%
******Unilateral undescened palpable: 15%
******Unilateral undescened impalpable: 50% 
*******Unilateral undescened impalpable with posterior urethral meatus: 65%
******* Unilateral undescened impalpable with anterior urethral meatus: 5-8%
*****Bilateral undescended testes and hypospadias: 32%
******Bilateral undescended palpable: 16%
******Bilateral undescended impalpable: 50%
**'''Penile size should be assessed and an accurate measure of stretched penile length recorded.'''
***Recall, the mean stretched penile length in full-term males born in the United States is 3.5 cm
**'''Presence of a uterus can be assessed by physical exam but a more precise means of assessing müllerian anatomy is by pelvic US''', which may be performed immediately in the neonatal period.
***'''In addition to defining müllerian anatomy and confirming the presence or absence of a uterus, the gonads and adrenals should be studied.'''