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DES exposure in utero Images (Click to view larger image)
Alternative Names
diethylstilbestrol exposure in the womb
Definition
From the 1940s to the 1970s, diethylstilbestrol (DES) was used in some pregnant women to prevent miscarriage. Many sons and daughters of women who used DES have developed abnormalities of the reproductive organs.
What is going on in the body?
A woman who was exposed to DES in her mother's uterus may have abnormalities in her cervix, uterus, or vagina. A man who was exposed to DES in his mother's uterus may have abnormalities in the size of his penis, the opening of the urethra, and the testicles.
What are the signs and symptoms of the condition?
A woman who was exposed to DES in utero may have symptoms, including: A man who was exposed to DES in utero may have: - underdeveloped or undescended testicles
- hypospadias, a condition in which the opening to the urethra is located on the underside of the penis
- varicocoele, a condition in which the veins of the testicles are enlarged
- a small penis
- meatal stenosis, which is narrowing of the opening of the urethra on the end of the penis
- epididymal cysts, which are noncancerous tumours on the back of the testicles
What are the causes and risks of the condition?
Exposure to DES in the mother's uterus causes these problems in both men and women.
What can be done to prevent the condition?
Since the sons and daughters of women who took DES were exposed to DES during foetal development, there is no known way to prevent the defects present at birth. Women exposed to DES in utero have a higher risk of developing certain rare cancers of the cervix and vaginal cancer. So more frequent PAP smears and colposcopy may be needed. A colposcopy uses a special scope to look at the cervix and vagina.
A son who was exposed to DES in utero should also have regular physical examinations, including regular prostate and rectal examinations. He should also perform regular monthly testicular self-examination, and report any suspicious changes or concerns to the doctor.
How is the condition diagnosed?
Abnormalities of the cervix or vagina in women are usually seen on a pelvic examination done by a doctor. PAP smears may be abnormal. If repeated PAP smears are abnormal, colposcopy is often done. A biopsy may also be done of the cervix and vagina to look for any cancerous changes.
Abnormalities of the penis, testicles, or urethra in men are generally seen on physical examination.
What are the long-term effects of the condition?
If a DES-exposed woman becomes pregnant, she should be watched for any signs of problems. These may include miscarriage, ectopic pregnancy, or premature labour.
A DES-exposed man is at risk for infertility, which may be caused by undescended testicles. He may also develop epididymal cysts, or noncancerous growths on the back of the testicle.
What are the risks to others?
DES exposure affects only the offspring of the particular pregnancy in which the mother was given the medication. DES did not cause similar disorders in the mother. The disorders cannot be passed to others by sexual contact, and will not be passed to children of DES-exposed parents.
What are the treatments for the condition?
A cervix or vagina abnormally shaped by DES cannot be corrected by surgery. If the vagina has a septum wall, the septum can be removed easily in an outpatient procedure. If the woman has an Incompetent cervix during pregnancy, a cervical cerclage may be used to suture the cervix closed.
A woman with cancer of the cervix or vagina may need radical hysterectomy to remove the uterus, ovaries, and cervix, or a vaginectomy to remove the vagina. radiation therapy may be performed to treat the cancer.
Surgery to correct undescended testicles may be done in men, as well as hypospadias repair.
What are the side effects of the treatments?
By itself, in utero exposure to DES does not cause side effects in the offspring later in life. But if the DES causes cervical, vaginal, or testicular cancer, treatments for the cancer may have side effects. Surgery, Radiation therapy, and chemotherapy all have various side effects. Surgery can cause bleeding, infection, and allergic reaction to the anaesthesia. Chemotherapy may cause stomach upset, hair loss, and decreased resistance to infection.
What happens after treatment for the condition?
If a DES-exposed woman becomes pregnant, her pregnancy will be considered high risk and she will be closely monitored. Surgery may be needed for more serious recurrent symptoms, infertility, or cancer. Recovery from surgery may be a few days to several weeks depending on the type of surgery done.
How is the condition monitored?
Men and women who were exposed in utero to DES should have yearly examinations to watch for serious complications such as cancer. Any new or worsening symptoms should be reported to the doctor.
Author:
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 23/07/2005
Contributors
Potential conflict of interest information for reviewers available on request |
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