So ugly it reminds you of piss. Could also refer to how they smell with the small of piss
Bob: Oh dude Stephanie is kinda hot
Jorge: Nah dude she's piss-ugly
Bob: You gay?
Basically a chick who looks like a hideous dude with tits and pussy and a long hair which looks like a wig.
Ethel is huge dork ugly chick. She looks like a fat dude with a wig having tits and pussy rather than a proper feminine appearance
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