Ambiguous genitalia is a birth defect where the outer genitals do not have the typical appearance of either a boy or a girl. The genetic sex of a child is determined at conception. The mother's egg cell contains an X chromosome , while the father's sperm cell contains either an X or a Y chromosome. These X and Y chromosomes determine the child's genetic sex. Normally, an infant inherits 1 pair of sex chromosomes, 1 X from the mother and 1 X or one Y from the father.
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Clitoromegaly - Wikipedia
Ambiguous genitalia is a rare condition in which an infant's external genitals don't appear to be clearly either male or female. In a baby with ambiguous genitalia, the genitals may be incompletely developed or the baby may have characteristics of both sexes. The external sex organs may not match the internal sex organs or genetic sex. Ambiguous genitalia isn't a disease, it's a disorder of sex development. Usually, ambiguous genitalia is obvious at or shortly after birth, and it can be very distressing for families. Your medical team will look for the cause of ambiguous genitalia and provide information and counseling that can help guide decisions about your baby's gender and any necessary treatment. Your medical team will likely be the first to recognize ambiguous genitalia soon after your baby is born.
The Anatomy of the Clitoris
For example, a person might appear to be female on the outside at birth, but have mostly male-typical reproductive organs inside. In another case, a person may be born with genitalia that seems to fall in-between the usual male and female types—for example, a female may be born with a noticeably large clitoris or lack a vaginal opening , or a male may be born with a notably small penis , or with a scrotum that is divided so that it has formed more like labia. A person may be born with mosaic genetics , so that some of their cells have XX chromosomes and some of them have XY. Sometimes a person is not found to have intersex anatomy until they reach the age of puberty , experience infertility issues as an adult, or passes away and is autopsied. Some people live and die with intersex anatomy without anyone including themselves ever knowing.
Clitoromegaly or macroclitoris  is an abnormal enlargement of the clitoris that is mostly congenital or acquired, though deliberately induced clitoris enlargement as a form of female genital body modification is achieved through various uses of anabolic steroids, including testosterone , and may also be referred to as clitoromegaly. The different grade of genital ambiguity is commonly measured by the Prader classification ,  which ranges, in ascending order of masculinisation, from 1 : female external genitalia with clitoromegaly through 5 : pseudo-phallus looking like normal male external genitalia. Clitoromegaly is a rare condition and can be either present by birth or acquired later in life. If present at birth, congenital adrenal hyperplasia can be one of the causes, since in this condition the adrenal gland of the female fetus produces additional androgens and the newborn baby has ambiguous genitalia which are not clearly male or female.