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Diethylstilbestrol Exposure

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Diethylstilbestrol Exposure, Diethylstilbestrol, DES, DES Exposure

  • See Also
  1. Teratogen
  • Background
  1. Diethylstilbestrol (DES) is an oral synthetic nonsteroidal Estrogen
  2. Diethylstilbestrol (DES) was prescribed in pregnancy
    1. Was used to improve pregnancy outcomes
    2. Later studies did not support any benefit for DES
    3. Used in U.S. 1938 to 1971
    4. Used in Europe until 1980's
  3. Diethylstilbestrol (DES) is now only indicated in men with advanced Prostate Cancer
  • Associated Conditions
  • DES Exposure (highly correlated)
  1. Associated with in utero exposure to DES
  2. Highest risk were patients exposed in first trimester
  3. Carcinoma
    1. Vaginal clear cell adenocarcinoma
      1. Peak onset age 17 to 22 years
      2. Possibly second peak at post-Menopause
    2. Breast Cancer (same risk as Hormone Replacement)
  4. Gynecologic tract abnormalities
    1. T-shaped Uterus
    2. Adenosis
    3. Cervical abnormalities (e.g. pseudopolyp)
  5. Risks in men exposed in utero to DES
    1. Undescended Testes
    2. Small Testes
    3. Possible Prostate Cancer risk
    4. Possible Testicular Cancer risk
  • Management
  • Surveillance of women with in utero DES Exposure history
  1. Colposcopy at first Pap Smear
    1. Repeat annually (at minimum) for abnormalities
    2. Routine Colposcopy not needed if normal
  2. Annual Pap Smear, four quadrants and pelvic exam
    1. Sample cells with brush from four vaginal quadrants
    2. Routine Pap Smear
    3. Bimanual exam
  3. Pregnancy management
    1. Discuss higher risk of Miscarriage and poor outcomes
    2. Refer to obstetrics if pregnant
  • References
  1. Giusti (1995) Ann Intern Med 122:778-88 [PubMed]
  2. Schrager (2004) Am Fam Physician 69:2395-402 [PubMed]