Prenatal diethylstilbestrol exposure and human genital tract abnormalities

Herbst AL, Scully RE, Robboy SJ, DES research 1979

foetus image
Nonneoplastic abnormalities including vaginal adenosis, cervical eversion (ectropion), and transverse cervical and vaginal ridges are frequent in the DES-exposed population, particularly if the drug was administered early in pregnancy.

1979 Study Abstract

The incidence of clear cell adenocarcinoma of the vagina and cervix associated with intrauterine exposure to diethylstilbestrol DES and similar compounds during the first half of pregnancy has increased. Ninety percent of these cancers have occurred in patients 14 years of age or older.

Although these carcinomas are exceedingly rare, nonneoplastic abnormalities including vaginal adenosis, cervical eversion (ectropion), and transverse cervical and vaginal ridges are frequent in the exposed population, particularly if the drug was administered early in pregnancy. Current evidence favors a disturbance in development of the müllerian duct as the explanation of these changes.

Whether DES is only a teratogen or also a carcinogencerviccervi is unknown, as is the possible role of other factors in the development of cancer. An increased incidence of cancer among exposed males has not been documented.

Sources and more information
  • Prenatal diethylstilbestrol exposure and human genital tract abnormalities, Herbst AL, Scully RE, Robboy SJ. 1979 May;(51):25-35. NCBI PMID: 481577.
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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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DES-exposed women presenting with vaginal discharge and cervical ectropion

DES clinic, maternity hospital, Dublin, Ireland, 1999

woman-thinking image
Not just a cervical ectropion: three case reports of 22, 22 and 26 years old patients from a DES clinic in Dublin, Ireland.
Vaginal discharge image by Bangladesh Press © all rights reserved.

1999 Report Abstract

Typical changes in the cervix are described in three women following in utero exposure to diethylstilbestrol. It is important that these changes are recognised on colposcopy and appropriate follow-up colposcopy arranged. In the absence or cervical intraepithelial neoplasia, local destructive therapy is not indicated as this may be associated with cervical stenosis.

Sources and more information
  • Not just a cervical ectropion. Three case reports of diethylstilbestrol (DES) exposed women presenting with vaginal discharge and cervical ectropion, NCBI PMID: 15512425, J Obstet Gynaecol. 1999 Nov;19(6):649-51.
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DiEthylStilbestrol and other Sex Hormones during Pregnancy

DES has terrible side-effects in DES Daughters, DES Sons, DES Grand-Children…

Diethylstilbestrol and other sex hormones during pregnancy
In utero exposure to Diethylstilbestrol is associated with terrible side-effects in DES Daughters, DES Sons, DES Grand-Children

Intrauterine exposure to diethylstilbestrol (DES) has been associated with this subsequent rare development of clear cell adenocarcinoma of the vagina and cervix in exposed female progeny. These tumors have been seen thus far in patients between the ages of 7 and 29 years. In addition, nonmalignant epithelial and structural genital alterations have been frequently observed. The epithelial changes of adenosis, ectropion, metaplasia, and potential neoplasia are considered. Thus far, no increased risk of squamous cell neoplasia has been demonstrated in DES-exposed subjects. However, increased pregnancy wastage, including premature birth, does appear to be more common among DES-exposed women; this increase may be related to the structural uterine and cervical changes that have occurred. DES-exposed men have been demonstrated to have anatomic genital changes, but the effects of these changes, if any, on male infertility are not known. Masculinization of the female external genitalia, including phallic enlargement and labioscrotal fusion, has been reported following intrauterine exposure to certain progestational agents and androgens.

Sources: Diethylstilbestrol and other sex hormones during pregnancyNCBI, Dr Herbst A, Nov 1981.

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