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Health
Risks of DES Exposure |
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| DES
Daughters |
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Cancer and Adenosis
The identification of a rare form of vaginal
cancer (clear cell adenocarcinoma) in young women exposed to DES is what prompted the
government to ban use of the drug in pregnancy. Fortunately, the risk of cancer from DES
exposure appears to be small, less than one in 1000 DES daughters. However, it is
important for your doctor to know of your DES exposure so that he or she can perform
special examinations necessary to prevent or detect this cancer.
Every year (or more often) you should have a
four-part gynecological exam. DES specialists are most familiar with this exam, but any
qualified OB/GYN can perform it.
1) a thorough pelvic exam with careful visual examination of the cervix and
vagina
2) a very careful palpation (manual feeling) of the vaginal walls and bimanual
examination where the doctor pushes on your outer abdomen while inserting a finger into
the vagina
3) Pap smear of the cervix (this is the one that all women receive)
4) Pap smear of the vagina (a special "four-quadrant" smear of all
four sides of the vagina). This is the most important part of the exam, since the majority
of the cases of clear cell adenocarcinoma have arisen in the vagina, as opposed to the
cervix. The vagina is typically obscured by the speculum in a routine exam.
Your very first DES gynecologic exam should probably
also include staining of the vaginal tissue to determine the presence of any abnormal
cells. DES daughters often have tissue changes of the vagina known as "adenosis"
which is the presence of glandular tissue where smooth, connective tissue should be. The
easiest way to explain it is if the tissue inside of your mouth were to be present on the
outside of your face. Adenosis can result in frequent vaginal irritation or infection.
Another important test for DES daughters is a
"colposcopy". This is an examination of the cervix and vagina through a lighted
magnifying scope to detect the presence of tissue changes not visible to the
examiner’s naked eye. Sometimes small biopsies are taken if suspicious areas are
present.
Reproductive Tract Abnormalities
A very large proportion of DES daughters have physical
abnormalities of the reproductive organs due to their exposure. These structural changes
of the fallopian tubes, cervix and uterus can result in multiple
miscarriages, tubal or ectopic pregnancies, premature births, and primary and secondary infertility.
The DES-related changes in the cervix are often
referred to as "collars", "hoods", or "cockscombs" to
physically describe the extra folds of tissue that surround or distort the cervix. In the
uterus, DES exposure is manifested in misshapen, constricted, and hypoplastic or smaller
than normal uterine cavities which make it difficult for a fertilized egg to attach, often
resulting in miscarriage and/or infertility. Doctors often refer to these uterine changes
by another descriptive term, the "T-shaped" uterus, because the DES-exposed
uterus often resembles the shape of the letter "T" as opposed to the normal
upside-down pear shape.
High-Risk Pregnancies
DES daughters have a greatly increased risk for ectopic pregnancy, miscarriage, incompetent cervix and preterm labor and
delivery. All DES daughters require high-risk prenatal care and early confirmation of
their pregnancies. Perinatologists are doctors specializing in high risk pregnancies, and
if your insurance plan permits it, you should consider consulting with one of these
specialists. It is wise to discuss the potential effects of your exposure with your doctor
before you try to become pregnant. If you have cervical abnormalities, your doctor may
recommend a cerclage, or a stitching shut of the cervix, during the first trimester which
can prevent premature dilation of the cervix.
Auto-Immune Disorders
DES daughters are also apparently at increased risk for
various auto-immune disorders such as lupus, rheumatoid arthritis, ulcerative colitis,
optic neuritis, and thyroid conditions. Some studies have shown that women with adenosis
appear to have an even greater risk of those conditions. Make your doctor aware of your
DES exposure.
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| DES
Sons |
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DES also
affected male children of the women who took it. Studies have shown that some DES sons are
at increased risk for one or more genital problems. These include underdeveloped tests,
epididymal cysts, undescended testicles and lowered sperm counts resulting in decreased
fertility. Other studies have demonstrated an increased risk in testicular cancer,
although these results are somewhat controversial. If you are a DES son, you should see a
urologist for a thorough examination. |
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| DES Mothers |
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Studies have shown that the women who took DES during
their pregnancies have an increased risk of breast cancer. Make sure your physician knows
that you ingested DES during your pregnancy before beginning hormone replacement therapy.Next> |
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