Pseudovaginal perineoscrotal hypospadias

Pseudovaginal perineoscrotal hypospadias (PPSH) refers to a configuration of the external genitalia of an infant. In a sense, this configuration is roughly midway between normal male genitalia and normal female genitalia in structure and appearance. It is a relatively common form of genital ambiguity caused by undervirilization of genetic males due to several different intersex conditions.

Presentation
PPSH usually consists of: Testes are often palpable in the scrotum or inguinal canals, and the karyotype is XY. In most cases there are no internal female structures such as a uterus or other mullerian duct derivatives.
 * a phallus midway in size between penis and clitoris,
 * a chordee tethering it to the perineum,
 * a urethral opening usually on the perineum (the hypospadias),
 * and an incompletely closed urogenital opening, which resembles a small and shallow vagina.

Causes
It is considered a form of 5-alpha-reductase deficiency involving SRD5A2.

Management
When an infant is born with PSH, the most difficult management decision has often been the sex assignment, since genitalia with this degree of ambiguity do not resemble either sex very well with respect to looks or function. Many infants with PPHS have been assigned and raised as female despite presence of testes and XY chromosomes.

Nearly all infants with PPSH are offered surgical reconstruction, to either further masculinize or feminize the external genitalia.

Treatment with testosterone postnatally does not close the urethra or change the malformation, but in some cases may enlarge the penis slightly.