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The way I understand it is that everyone starts out having an urogenital sinus...when they are developing in the womb. But, if a girl develops normally, the urogenital sinus ends up "disappearing" and separating into the urethra and vagina. In girls with CAH, this sometimes doesn't happen....the urogenital sinus persists and the urethra and vagina end up joining together somewhere internally. When virilization is severe, the two join together far from where they would both normally exit the body. When virilization is less severe, they join together close to where they would normally exit the body.
I am still learning about this, so may not have this absolutely right...but I think it is generally correct. At any rate, the concern I have is that the positioning of the urethra and vagina are abnormal in girls with CAH. And the more I think about it, the more problems I think that may cause.
