Review Question - QID 214469

A 2-year-old girl is brought in by her father for urogenital pain. The father states that the patient complains of pain with urination, which has gotten worse over the past 4 months. He also reports that her diapers are constantly “damp” with urine. The patient is an otherwise healthy child. She can say sentences with 2-4 words, can name some animals, and has started to climb up and down the stairs. The patient’s father states that she has a history of infantile eczema. She uses topical hydrocortisone ointment as needed. On examination, the labia minora are fused, the urethral meatus is partially obstructed, and the vaginal opening is not visible. Which of the following is the most likely cause of the patient’s symptoms?