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Living with 46,XX disorder of sex development-anorectal anomalies syndrome

A rare condition present at birth with differences in the genitals, urinary tract, and bowel opening.

Understanding 46,XX disorder of sex development-anorectal anomalies syndrome

46,XX disorder of sex development-anorectal anomalies syndrome is a rare condition that affects development before birth.

People have a typical female chromosome pattern and ovaries, but may have male or ambiguous-looking genitals. Urinary tract differences range from mild to missing kidneys. Müllerian duct differences (such as an absent uterus and vagina) and an anus that is not open (imperforate anus) can occur. Other features can include a tracheoesophageal fistula or gut malrotation. GARD lists onset as newborn.

Signs & symptoms

Symptoms vary from person to person. GARD lists these among the most common:

  • Anus not open (anal atresia)
  • Missing or small kidney
  • Swollen kidney from backed-up urine (hydronephrosis)
  • Genitals that are not clearly typical
  • Differences in internal genitals
  • Low amniotic fluid during pregnancy

Not everyone has every symptom. GARD's list comes from the Human Phenotype Ontology.

Diagnosis

  1. Talk with your doctor

    Share the symptoms you've noticed, when they started and your family health history. Notes and photos can help.

  2. See a specialist

    Specialists who may be involved include digestive system specialists, genetic specialists, hormone specialists and maternal-fetal medicine specialists.

  3. Ask which tests can help

    Your care team will decide which exams and tests can confirm the diagnosis.

Care & treatment

Care team
Digestive system specialists (gastroenterologists); Genetic specialists (geneticists); Hormone specialists (endocrinologists); Maternal-fetal medicine specialists (pregnancy-related)
Expert care
Ask about multidisciplinary care centers for rare conditions
Treatment
GARD doesn't list specific treatments for this condition. Your care team will tailor care to your symptoms.
Research
Clinical trials and observational studies may be options. See the research section below.

General information, not medical advice. Your care team makes the decisions.

Everyday life

Living with a rare condition is easier with support.

  • Connect with Pull-thru Network
  • Keep notes on symptoms, changes and questions for appointments
  • Ask about patient registries that help research
  • Look into financial aid and travel resources for care visits
Bring these questions to your next doctor visit
Which specialists should follow my child's kidneys, bowel, and hormones?
Do we need surgery or imaging for the anus and urinary tract?
What does genetic testing show?

Quick facts

Symptoms usually startNewborn

GARD says changes in genes (also called variants) cause this condition. The summary describes it as a developmental defect during embryo growth.

GeneticEndocrineGastrointestinalUrinary and Reproductive

Also known as: 46,xx disorder of sex development with anorectal anomalies syndrome; female pseudohermaphroditism with anorectal anomalies syndrome; female pseudohermaphroditism-anorectal anomalies syndrome

Patient organizations

  • Pull-thru Network46,XX disorder of sex development-anorectal anomalies syndrome · United States
Source: NIH GARD · 46,XX disorder of sex development-anorectal anomalies syndromeGARD ID 18782 · GARD page updated September 2026 · Plain-language summary by Know Rare; editorial review pending. General information, not medical advice.

You are more than your diagnosis

Perspectives from people navigating life with 46,XX disorder of sex development-anorectal anomalies syndrome.

Explore the 46,XX disorder of sex development-anorectal anomalies syndrome blog

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