Penile agenesis is a rare anomaly, occurring once in every 30 million births. Early gender reassignment and genital reconstruction helps the family to accept the child's altered gender and to reduce psychological problems. In the past, multiple operations were carried out to form feminized external genitalia. This report describes a single-stage gender reassignment and genital reconstruction by anterior sagittal anorectovaginourethroplasty in a neonate with penile agenesis.