The first step is to understand the child's gender. The next step is to consider treatment and support for the child's emotional well-being.
Treatment depends on what caused the problem. Treatment often involves reconstructive surgery. This would remove or create appropriate sex organs. Surgeons with experience can offer very normal looking results. Hormone replacement therapy (HRT) is also often part of the treatment plan.
For girls with mild congenital adrenal hyperplasia, surgery may not be needed. Hormone therapy may be all that she needs. When the imbalance is managed, she can live a normal life. If the vagina is blocked, surgery would help. This is often done within the first 12-18 months of life.
With vaginal surgery, care is taken to protect clitoral sensitivity. The goal is to prevent injury to the sensory nerves and blood supply. Often, a new opening with vaginal surgery is thin. More surgery may be needed as the child grows. Or, exercises to “stretch” the opening may be done before sexual activity begins.
Surgery for boys with severe hypospadias is often successful. It forms a longer, free penis that can look normal. Any separation of the scrotal sacs would be repaired at the same time. Surgery is done in one or two stages between 6 and 18 months of age. Once healed, the penis grows in pace with normal physical growth. Surgery doesn't harm a boy's ability to feel sensation or have an erection.