Recent publications claim there may be 60 different syndromes that can lead to a disorder of sex development (DSD). Congenital adrenal hyperplasia (CAH), partial androgen insensitivity syndrome, hypospadias, epispadias, bladder and cloacal exstrophy, Klinefelter syndrome, enzyme insufficiencies like 5-alpha reductase or 17-beta ketosteroid, and MRKH, CHARGE, and other syndromes all may have ambiguous genitalia as part of their presentation.