Psychological effects of diethylstilbestrol exposure

Guilt: the most common problem among DES mothers

This 1977 study concluded that sensitivity and good communication on the part of medical personnel are recommended.

Study Abstract

The Journal of The American Medical Association, doi:10.1001/jama.1977.03270300056007, January 17, 1977

The psychological response of daughters and their mothers to discovery of in utero diethylstilbestrol (DES) exposure was studied.

At the DES Colposcopy Clinic, 41 daughters and 20 mothers were extensively interviewed. Twelve patients with abnormal cytology tests were controls.

Initial anxiety was usually followed by acceptance of the condition after examination and counseling. Patients responded best when informed of their problem by their mothers and when the relationship between mother and daughter was good. The majority of patients found colposcopy to be unpleasant; they tended to be disturbed in proportion to the degree of being upset about DES exposure. The most common problem among mothers was guilt.

A questionnaire survey of physicians showed that they had less concern for psychological problems than patients or mothers did. Sensitivity and good communication on the part of medical personnel are recommended.

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Management of females exposed to DES-type drugs ; 1977 recommendations

Vaginal and cervical cancers and other abnormalities associated with exposure in utero to diethylstilbestrol and related synthetic hormones

woman-at-hospital
1977 study and recommendations about vaginal and cervical cancers and other abnormalities associated with exposure in utero to diethylstilbestrol and related synthetic hormones. all you’ve been through.

1977 Study Abstract

All asymptomatic girls who wore exposed to diethylstilbestrol in utero should receive a thorough pelvic examination at menarche or if they have reached 14 years of age. Younger girls should be examined if they develop abnormal bleeding or discharge. Whenever prenatal exposure is probable and theme are symptoms of discharge, further investigation is imperative, regardless of the patient’s age. This investigation should not be concluded until it is certain that no lesion is present.

Before the examination is undertaken, the entire procedure should be thoroughly discussed with the patient (and her mother on father if she is a minor).

The examination should include inspection and palpation, Papanicolaou smear (cervix and vagina), and an iodine staining test of the entire cervix and vagina. Abnormal areas, including those that do not stain with iodine, should be biopsied.  This procedure can be performed in the physician’s office with small biopsy instruments and without significant discomfort.

For the very young patient who has symptoms that require investigation, anesthesia may occasionally be required be fore an examination. A small speculum permits adequate visualization of the vagina without undue discomfort in younger patients.

With asymptomatic females, if adequate examination is not possible at the initial visit, vaginal tampons should be used for a few months to allow an adequate examination later without discomfort. Colposcopy is a useful adjunct to this examination, but it is not essential. Utilizing its low power magnification to examine the vagina and cervix, the physician can identify areas of glandular tissue (adenosis) in the vagina on on the cervix. This identification permits directed rather than “blind” biopsies. When used in con junction with the iodine staining test and selected biopsy, colposcopy permits precise recording of observed abnormalities and their appraisal at fixed intervals.

The patient exposed to DES-type drugs should be followed on a regular basis. After a normal initial examination, annual pelvic examinations with cervical and vaginal cytology and iodine staining are probably adequate. If any abnormalities are noted during the initial evaluation, more frequent follow-up examinations are suggested (every 3 to 6 months, depending on the severity of the findings).

Locally destructive measures such as cauterization, cryosurgery, or excision can be utilized if atypical changes such as marked squamous dysplasia on carcinoma in situ of the vagina or cervix are found on biopsy.

Sources and more information
  • Vaginal and cervical cancers and other abnormalities associated with exposure in utero to diethylstilbestrol and related synthetic hormones, Cancer Research, 1977 Apr.
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Upper genital tract changes associated with exposure in utero to diethylstilbestrol

American journal of obstetrics and gynecology, 1977

woman-in-the-dark
1977 study : in none of the control subjects were defects noted which could be considered comparable with those seen in the DES-exposed patient.

1977 Study Abstract

Hysterosalpingograms of 60 young women exposed in utero to diethystilbestrol were obtained.

In 46 instances, documentation of this exposure was obtained from the mother’s chart review or confirmed by the attending physician. In 14 instances, the patients’ mothers were sure they had received stilbestrol, but documentation could not be specifically confirmed.

  • In 40 women exposed to stilbestrol, changes in the uterus which differed significantly from those seen in the past in nonexposed individuals were noted. These changes consisted of:
    • a ‘T-shaped appearance of the uterus,
    • ‘ constricting bands in the uterine cavity,
    • a hypoplastic uterus,
    • and less frequently, intrauterine polypoid defects,
    • synechiae,
    • and in one instance a unicornuate uterus.
  • In 36 of the 40 women gross defects were also noted in the cervix.

Hysterosalpingograms of 23 women being investigated for infertility during the same period that the current study was conducted were also reviewed.

  • By comparison, in none of the control subjects were defects noted which could be considered comparable with those seen in the DES-exposed patient.
Sources and more information

Upper genital tract changes associated with exposure in utero to diethylstilbestrol, American journal of obstetrics and gynecology, NCBI PMID: 851159, 1977 May 1.

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Epidemiology of vaginal adenosis and adenocarcinoma associated with exposure to stilbestrol in utero

US National Library of Medicine National Institutes of Health, 1977

image of woman thinking
While the risk of developing adenocarcinoma appears to be very low, a majority of exposed females do have other abnormalities of the lower genital tract. Almost sad – m00by by M.E. Aguila.

1977 Study Abstract

Following the observation that maternal ingestion of diethylstilbestrol was associated with the development of adenocarcinoma of the vagina in young women, analysis of 170 cases of the disease, collected over a two-year period, was undertaken. Details of history of non-steroidal estrogenic intake during pregnancy, its dosage and duration of intake and prevalence of concomitant abnormalities of the vagina and cervix were recorded.

This analysis disclosed that dosage and duration of intake do not appear to be vital factors in contributing to the development of carcinoma. A controlled, prospective investigation of prenatal exposure to stilbestrol was also carried out. Vaginal and cervical abnormalities were common among 110 young women exposed to stilbestrol in utero. Biopsy-proved vaginal adenosis was present in 35% of the exposed population as compared with only 1% of the control subjects. Fibrous ridges of the vagina and cervix and failure of the vaginal mucosa and portions of the cervix to stain with iodine were also more frequently observed in the exposed population.

While the risk of developing adenocarcinoma appears to be very low, a majority of exposed females do have other abnormalities of the lower genital tract. While some investigators believe that adenosis is a premalignant lesion, at present there is no clear-cut evidence of transition from adenosis to adenocarcinoma.

Sources and more information
  • Epidemiology of vaginal adenosis and adenocarcinoma associated with exposure to stilbestrol in utero, Cancer. ;39(4 Suppl):1892-5., Poskanzer DC, Herbst AL., NCBI PMID: 856457, 1977 Apr.
  • Full study, Volume 39, Issue Supplement S4, PDF, Article first published online: 27 JUN 2006
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Prenatal exposure to synthetic progestins and estrogens: effects on human development

People in the psychiatric community have definitely known since the 1970s that prenatal exposure to estrogens or progestins causes permanent, lifelong changes in that person’s personality and behaviour…

Thanks to Hugh Easton for this study find and comment:

Here’s a particularly shocking piece of research, which shows that it’s been known since at least the 1970s that prenatal exposure to estrogens and progestins can produce lifelong alterations to peoples’ personality and behaviour. From there, It’s not an enormous leap to them also affecting gender identity!

Abstract:

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People in the psychiatric community have definitely known since the 1970s that prenatal exposure to estrogens or progestins causes permanent, lifelong changes in that person’s personality and behaviour…

Seventy-one offspring of mothers administered combinations of synthetic progestins and estrogen for the maintenance of at-risk pregnancy were evaluated for their performance on IQ and personality tests. Siblings born of untreated pregnancies acted as controls. Hormone-exposed subjects were partitioned into three treatment subgroups dependent on the ratio of progestin to estrogen administered to their mothers during pregnancy. No difference in IQ was obtained among the three treatment subgroups even when scores were adjusted for sibling score and prenatal and perinatal complications. Responses to the personality questionnaire provided significant differences among the three groups. The group exposed to the progestin regime (progestin alone or in combination with very low doses of estrogen) and the estrogen regime (higher doses of estrogen than progestin) were most dissimilar. Progestin regime exposed subjects were characterized as more independent, sensitive, self-assured, individualistic, and self-sufficient. In contrast, the subjects exposed to the estrogen regime were more group oriented and group dependent. Analysis of difference scores generated by subtracting the score of an unexposed sibling from that of the exposed cosibling provided similar results. A general discussion is presented on the efficacy of hormone treatment for pregnancy maintenance, augmented fetal wastage of males, birth order and treatment, maternal knowledge of treatment and its possible postnatal effects on the offspring, and drug effects on the fetus.

Sources:
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Risk of DiEthylStilbestrol-related Clear Cell Adenocarcinoma of the Vagina and Cervix

Age-incidence and risk of diethylstilbestrol-related clear cell adenocarcinoma of the vagina and cervix

Age-incidence and risk of diethylstilbestrol-related clear cell adenocarcinoma of the vagina and cervix
Cumulative risk of this type of genital cancer in the DES Daughters

This study was based on cases accessioned in the Registry of Clear Cell Adenocarcinoma of the Genital Tract in Young Females to ascertain the incidence of diethylstilbestrol (DES)-related cancers by age and year of birth. For accuracy in estimating the size of the reference population for the incidence rates, calculations were restricted to 127 white residents of the United States who were exposed prenatally to DES or other nonsteroidal synthetic estrogens. The disease is exceedingly rare prior to age 14 when the incidence rate begins to rise rapidly. The incidence peaks at age 19 (median 19.2 years) and then drops precipitately. Thus, DES-related clear cell adenocarcinoma is unusual in that nearly all cancers have been diagnosed in a narrow age range of 10 years (14 to 23 years). Women born in 1951 to 1953 have higher incidence rates than those born in the previous or subsequent three-year period. This suggests that the prevalence of pregnancy-related use of DES was at a peak in the early 1950’s. The cumulative risk of this type of genital cancer, through age 24, for DES-exposed female subjects is estimated to be in the range of 0.14 to 1.4 per thousand. The wide limits are due to the fact that the number of young women exposed is not known precisly. The low risk of disease and the narrow age range of the cases, relative to the long latency period, suggest that DES is an incomplete carcinogen. Other factors, possibly related to puberty, may be involved in the causation of this disease.

Sources: Age-incidence and risk of diethylstilbestrol-related clear cell adenocarcinoma of the vagina and cervix, NCBI, Dr Herbst A, May 1977.

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