Presence of neonate with ambiguous genetalia requires urgent attention to exclude life threatening condition such as adrenal insufficiency or electrolyte disturbance, and then the parents should be informed about the appearance of their infant genetalia appearance. Feminization genital reconstruction is much easier, however, the sex assignment depend on more than one factor some of them are anatomical & the others are psychological. The psychological aspects of the physical statement of gender assignment could perhaps be even more critical in the final picture of social adjustment. There are different methods for genital reconstruction of ambiguous genetalia, however the most controversial point is their timing, usually early surgical reconstruction is preferable to decrease the anxiety of the parents and to prevent development of psychosexual disorders of the infant.