- Diethylstilbestrol (DES) is an oral synthetic nonsteroidal Estrogen
- Diethylstilbestrol (DES) was prescribed in pregnancy
- Was used to improve pregnancy outcomes
- Later studies did not support any benefit for DES
- Used in U.S. 1938 to 1971
- Used in Europe until 1980's
- Diethylstilbestrol (DES) is now only indicated in men with advanced Prostate Cancer
- DES Exposure (highly correlated)
- Associated with in utero exposure to DES
- Highest risk were patients exposed in first trimester
- Carcinoma
- Vaginal clear cell adenocarcinoma
- Peak onset age 17 to 22 years
- Possibly second peak at post-Menopause
- Breast Cancer (same risk as Hormone Replacement)
- Vaginal clear cell adenocarcinoma
- Gynecologic tract abnormalities
- T-shaped Uterus
- Adenosis
- Cervical abnormalities (e.g. pseudopolyp)
- Risks in men exposed in utero to DES
- Undescended Testes
- Small Testes
- Possible Prostate Cancer risk
- Possible Testicular Cancer risk
- Surveillance of women with in utero DES Exposure history
-
Colposcopy at first Pap Smear
- Repeat annually (at minimum) for abnormalities
- Routine Colposcopy not needed if normal
- Annual Pap Smear, four quadrants and pelvic exam
- Sample cells with brush from four vaginal quadrants
- Routine Pap Smear
- Bimanual exam
- Pregnancy management
- Discuss higher risk of Miscarriage and poor outcomes
- Refer to obstetrics if pregnant