I'll give an intersex case for Mr. Dragon just for funsies (since I finished my exam for today
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Let's say you and and your partner are expecting and you get routine prenatal care. You get a gender reveal ultrasound at 18 weeks, which says you're going to have a baby girl because they don't see a PP on US. You and your partner spend all of your time choosing girl names and you're really excited to welcome a baby girl to the world.
Labor and delivery happens and your baby is born with healthy APGAR scores. However, the pediatrician looks at the genitals and can immediately see that something is not right. But since you (or your wife) just went through labor (you're exhausted/emotional), they're not going to tell you immediately that the genitals are weird so they let you have skin-to-skin with your newborn for one hour, and you think you have a baby girl because that's what you've been expecting this entire time and you don't even see a PP on your baby.
After the first hour, they do the routine newborn exam (baby gets taken to the nursery), and they do an ultrasound. They find undescended testicles internally around the area of the kidneys, and the neonatologist determines from this that the testicles will probably never descend and will need to be removed within a year or two because undescended testicles will turn into a cancer if it's not surgically removed.
Meanwhile, they document that the baby has an incompletely fused scrotum (aka a vaginal opening), a very small PP, as well as hypospadius (the urethra does not go out of the PP). After gathering all of this information, the doctor goes back into the postpartum room with you and explains that all of the things that they found -- that your baby is intersex (likely XY but it week take at least a week before the karyotype comes back) but has undescended testicles that need to be surgically removed or else they will turn into cancer.
Your baby will need to go on hormone replacement therapy as a teenager regardless because they won't have any testicles.
However, there are options. Option A is to suture the scrotum together (remove the vagina), with the assumption that you plan to raise your baby as a boy (on testosterone replacement therapy) who will grow up with a tiny micropenis. Option B is to expand the scrotal pouch ("vaginal" opening) with the assumption that you plan to raise your baby as a girl (on estrogen replacement therapy).
The pediatric urologist says that either option is fine, but it's better to do the surgery as a baby because if you wait until adulthood to do it, there's a much higher complication rate (like a ~20% complication rate as an adult versus a ~2% complication rate as a baby), so they recommend doing the surgery earlier because it's not good for quality of life if the surgeons have complications during surgery.
