The management of DES-exposed women: one physician’s approach

It is clear that DES has long-term effects that may develop over time

The finding of an incidence of 47% of cervical or vaginal intraepithelial neoplasia in 34 patients aged 10 to 26 years so treated to date indicates a high risk of potential candidacy for squamous carcinoma of the vagina or cervix in later years. Away we try to escape by Kei Kojishi.

1976 Study Abstract

The female offspring of diethylstilbestrol DES-treated mothers are examined cytologically and colposcopically annually, starting at the age of seven years no treatment is indicated until a colposcopic atypical transformation zone occurs. With its occurrence all the abnormal epithelium (squamous or columnar) is excised from the vagina and cervix under colposcopic guidance in the hospital or in the office under local anesthesia. The procedures are done in stages to minimize scarring and to eliminate the possibility of vaginal-cervical adhesions or vaginal shortening. The finding of an incidence of 47% of cervical or vaginal intraepithelial neoplasia in 34 patients aged 10 to 26 years so treated to date indicates a high risk of potential candidacy for squamous carcinoma of the vagina or cervix in later years.

Sources and more information
  • The management of DES-exposed women: one physician’s approach, The Journal of reproductive medicine, NCBI pubmed 957347; 16(6):285-8. 1976 Jun.
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Cytology of 575 young women with prenatal exposure to diethylstilbestrol

Obstetrics and gynecology, Dr Arthur Herbst, 1976

cytology lab image
This 1976 study indicates that the presence of mucinous columnar or metaplastic squamous cells in vaginal scrapes is suggestive of vaginal adenosis but that vaginal cytology cannot be considered a uniformly reliable screening technic for detecting the presence of this disorder.

1976 Study Abstract

The vaginal and cervical cellular changes encountered in 575 postpubertal females exposed prenatally to diethylstilbestrol (DES) were compared with those of an unexposed population with particular reference to the role of cytology in the detection of vaginal adenosis and cervical ectropion (erosion).

Several methods of obtaining specimens were utilized, the most effcacious of which was scraping of the vagina, especially the fornices, and the portio vaginalis of the cervix.
With this technic, columnar cells of the mucinous type and metaplastic squamous cells were observed in 34% of the vaginal scrapes and 54% of the scrapes of the cervical portio.
A higher incidence was apparent among those patients in whom iodine staining of the vaginal mucosa was abnormal or vaginal adenosis was proven by biopsy.
Moderate to severe dysplasia of the squamous cells or atypical glandular cells were found in 1% of the exposed subjects.

This study indicates that the presence of mucinous columnar or metaplastic squamous cells in vaginal scrapes is suggestive of vaginal adenosis but that vaginal cytology cannot be considered a uniformly reliable screening technique for detecting the presence of this disorder.

Sources and more information
  • Cytology of 575 young women with prenatal exposure to diethylstilbestrol, Robboy SJ, Friedlander LM, Welch WR, Keh PC, Taft PD, Barnes AB, Scully RE, Herbst AL., Obstet Gynecol. 1976 Nov;48(5):511-5. NCBI PMID: 980279.
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Urogenital tract abnormalities in sons of women treated with diethylstilbestrol

Urogenital abnormalities in men exposed to DES in utero, 1976

image of son-in-arms
In this 1976 survey, a large proportion of DES- exposed boys had experienced problems in passing urine and abnormalities of the penile urethra. Can’t let go image by Paolo Marconi.

1976 Study Abstract

Since in utero exposure to Diethylstilbestrol (DES) is known to cause abnormalities of the female genital tract later in life, exposed male offspring were located, surveyed by mail, and compared with unexposed male offspring from the same period and medical practices.

The exposed and unexposed respondents appeared comparable and did not differ in their response to most medical questions. However, a larger proportion of exposed than of unexposed boys had experienced problems in passing urine (12.9% vs. 1.8%, P = .0003) and abnormalities of the penile urethra (4.4% vs. 0%; P = .017).

Sources and more information

  • Urogenital tract abnormalities in sons of women treated with diethylstilbestrol, Pediatrics. NCBI PMID: 972792, 1976 Oct;58(4):505-7.
  • Urogenital abnormalities in men exposed to diethylstilbestrol in utero: a cohort study, NCBI, PMID: 19689815, 2009 Aug 18;8:37. doi: 10.1186/1476-069X-8-37. Full text PMC2739506.
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Vaginal Adenosis, Detection and Value of Screening Procedures

In utero DES-exposure associated with vaginal adenosis in DES Daughters

Value of screening procedures for the detection of vaginal adenosis
In utero exposure to Stilbestrol associated with vaginal adenosis in DES Daughters

Description:
Vaginal Adenosis (submucosal glands lined by mullerian-type epithelium) was rarely described in the past. It has been seen frequently in young women whose mothers took diethylstilbestrol and similar compounds during pregnancy. The adenosis can appear as a red granular lesion. Biopsy of these red areas as well as those that initially appear normal but fail to stain with Schiller’s iodine can usually be accomplished in the office. Although these glands appear to be benign, they
have been observed in close proximity to clear cell adenocarcinomas that have also occurred in young females whose mothers took stilbestrol during pregnancy. Present estimates suggest that the carcinomas are rare among the exposed population while adenosis occurs frequently. Although adenosis has been treated by surgical excision and local destruction (cauterization), the natural history of stilbestrol-associated adenosis is unknown. Close follow-up of patients with vaginal adenosis is certainly indicated and in many instances might prove to be the most prudent approach.

Study:
This study describes the use of routine vaginal iodine staining and other screening procedures for the detection of vaginal adenosis in 3871 postpubertal female patients. Iodine staining identified 65 patients with nonstaining areas in the vagina. Colposcopy verified the presence of vaginal adenosis in 11 of the 65 patients. Directed biopsies confirmed the diagnosis in 10 patients. The iodine staining procedure detected vaginal adenosis in only 1 patient who did not have a positive history of DES exposure or coexisting physical findings. Iodine staining of the vagina has little value as a screening procedure for the detection of vaginal adenosis. Based on these findings, a careful medical history and vaginal examination are recommended as the most productive routine screening procedures for vaginal adenosis. Evaluation and followup of those patients with a history of DES exposure in utero or physical findings suggestive of vaginal adenosis should include vaginal Papanicolaou smears supplemented by colposcopy at 6-month to 1-year intervals. Colposcopically directed biopsies of all abnormal areas should be obtained.

Sources: Value of screening procedures for the detection of vaginal adenosisNCBI, Dr Herbst A, Mar 1976

Screening for DES Daughters

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