II. Background
- Diethylstilbestrol (DES) is an oral synthetic nonsteroidal Estrogen
- Diethylstilbestrol (DES) was prescribed in pregnancy
- Was used to improve pregnancy outcomes
- Later studies did not support any benefit for DES
- Used in U.S. 1938 to 1971
- Used in Europe until 1980's
- Diethylstilbestrol (DES) is now only indicated in men with advanced Prostate Cancer
III. Associated Conditions: DES Exposure (highly correlated)
- Associated with in utero exposure to DES
- Highest risk were patients exposed in first trimester
- Carcinoma
- Vaginal clear cell adenocarcinoma
- Peak onset age 17 to 22 years
- Possibly second peak at post-Menopause
- Breast Cancer (same risk as Hormone Replacement)
- Vaginal clear cell adenocarcinoma
- Gynecologic tract abnormalities
- T-shaped Uterus
- Adenosis
- Cervical abnormalities (e.g. pseudopolyp)
- Risks in men exposed in utero to DES
- Undescended Testes
- Small Testes
- Possible Prostate Cancer risk
- Possible Testicular Cancer risk
IV. Management: Surveillance of women with in utero DES Exposure history
-
Colposcopy at first Pap Smear
- Repeat annually (at minimum) for abnormalities
- Routine Colposcopy not needed if normal
- Annual Pap Smear, four quadrants and pelvic exam
- Sample cells with brush from four vaginal quadrants
- Routine Pap Smear
- Bimanual exam
- Pregnancy management
- Discuss higher risk of Miscarriage and poor outcomes
- Refer to obstetrics if pregnant
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Related Studies
| des (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DESCOVY 200-25 MG TABLET | $66.13 each | |
| DESIPRAMINE 10 MG TABLET | Generic | $0.10 each |
| DESIPRAMINE 100 MG TABLET | Generic | $0.56 each |
| DESIPRAMINE 150 MG TABLET | Generic | $0.74 each |
| DESIPRAMINE 25 MG TABLET | Generic | $0.18 each |
| DESIPRAMINE 50 MG TABLET | Generic | $0.46 each |
| DESLORATADINE 5 MG TABLET | Generic | $0.34 each |
| DESMOPRESSIN 10 MCG/0.1 ML SPR | Generic | $7.86 per ml |
| DESMOPRESSIN ACETATE 0.1 MG TB | Generic | $0.33 each |
| DESMOPRESSIN ACETATE 0.2 MG TB | Generic | $0.42 each |
| DESOGESTREL-EE 0.15-0.03 MG TB | Generic | $0.15 each |
| DESOGESTR-ETH ESTRAD ETH ESTRA | Generic | $0.26 each |
| DESONIDE 0.05% CREAM | Generic | $0.49 per gram |
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| DESOXIMETASONE 0.05% CREAM | Generic | $2.61 per gram |
| DESOXIMETASONE 0.05% OINTMENT | Generic | $3.34 per gram |
| DESOXIMETASONE 0.25% CREAM | Generic | $0.62 per gram |
| DESOXIMETASONE 0.25% OINTMENT | Generic | $0.62 per gram |
| DESOXIMETASONE 0.25% SPRAY | Generic | $1.44 per ml |
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| DESVENLAFAXINE SUCCNT ER 100 MG | Generic | $0.52 each |
| DESVENLAFAXINE SUCCNT ER 25 MG | Generic | $0.52 each |
| DESVENLAFAXINE SUCCNT ER 50 MG | Generic | $0.48 each |