Hi Dana-
It would benefit you to look up the prader scale and it's great that you are trying to understand this part of CAH.
The prader scale is virilization from one to five where one would a "normal" size clitoris and five would favor a penis in the characteristics but the difference is the male penis is formed from a different way.
Prader five virilization where one voids through it is a result of a defunct adrenal gland that lacks the ability to make cortisone and thus the adrogens virilized the genital area thus this isn't a penis in the natural sense and would be in a way a clitoris that is a wanna be penis due to the metabolic glitch in the endocrine system- cah.
Way back in the day before CAH was understood - Some that were prader five were raised as male even though there wasn't any testes but later on it was found that this is a correctable adrenal gland condition and that a small percentage of the females are born with a genitals that look phallus like but really that is a result of the defect in the adrenal gland and thus surgery just like surgery for something like a heart defect.
But, the first help is to the metabolsim function in the body/adrenal gland by adding the cortisone and when you get that working then corrective surgery is done sooner or later on the external virilization of the genital area.
If I remember - this is your neice that you are asking about and it must of been something to learn all this. Girls that are born higher on the prader scale go on to have kids etc. Have you been told about adrenal crisis?
Dear Truth -
I don't know that much about Androgen Insensivity Syndrome but it is my understanding that externally a woman with ais has a "normal" external female genital area or an enlarged clitoris.
