The contribution of imaging in disorders of sex development is not confined to the diagnosis of the underlying condition. Imaging has an important role in assisting pre-operative planning where surgery is contemplated, in identifying the location of occult gonads and in assessment of suspected complications of these conditions, including malignant transformation. In each of these scenarios, close collaboration with paediatric endocrinologists and paediatric surgeons is essential if an appropriate management strategy is to be adopted, as imaging is of greatest value where the radiologist is aware of the context in which it is performed.