Dear anonymous,

I can only tell you what I would be looking for.  I am going to graduate from my women’s health care nurse pratitioner program in December.  When you went to the Gynecologist if they did not do a speculum exam just a pelvic exam he/she may not have noticed a difference with the vaginal canal.  If they did do a speculum exam they may have used a pediatric speculum after first trying a regular size one& thus may not notice as well. They may have thought the need for the pediatric speculum was b/c you were nervous (totally  understandable) because some people tense up their pelvic muscles when they are being examined and don’t even realize it.  I don’t say anything, just switch speculums and try to make it as easy on my patient as possible. When doing the exam, if the extrenal genitalia don’t look any different than expected (and believe me there are MANY different shades of what you expect to see!) again the GYN may not pick up a a subtle difference. The Urethra position I would think would be a clue, but to be honest my daughter is the only SWCAH genitalia I have seen. I have not had a CAH patient.  I have had patients with very tight vaginal openings, but the causes where other than CAH.  In those women I have used the pediatric speculum. 

I think that talking to the gynecologist is a good idea, but in all honestly they may have no clue what CAH is... just a vague bell from medical school.  A urologist would be better resource.  This is all just my opinion

Jessica