Disorders of sexual development (DSD) are a spectrum of conditions diagnosed in infancy resulting from atypical development of the external genitalia, in adolescence resulting from atypical pubertal development, or in adulthood as a result of infertility. Obstetricians may be the first health care providers to identify a disorder of sexual development in the fetus or newborn and should be part of the interdisciplinary team assembled to best care for these patients. Gynecologists must be familiar with the diagnosis and management of these conditions in late adolescence and adulthood. The creation of DSD “centers of excellence” may provide optimal care for individuals with these conditions but many will live too far from such centers and need to be followed by local gynecologists. The purpose of this commentary is to emphasize important medical and psychological issues so gynecologists can provide optimal care for their patients with DSD conditions.