Annual Exam for DES Daughters: Although health effects of DES exposure differ among DES Daughters, health care providers should monitor these women for abnormal genital tract structures, particularly for clear cell adenocarcinoma (CCA) of the **bleep** and cervix.
• Clinical breast exam
• Ask about interval bleeding or abnormal vaginal discharge
• Vulvar inspection
• Vaginal and cervical inspection
– Inspection of epithelial surfaces of **bleep**
– Rotation of speculum to view anterior & posterior walls of **bleep**
• Cytology
– Separate specimens from **bleep** fornices and cervix — all specimens placed on one slide or in liquid media
• Palpation of **bleep** and cervix (an essential part of the exam)
– Palpate entire length of **bleep**, including fornices
– Note ridges or structural changes
• Bimanual rectal-vaginal exam
• Biopsy, as needed
– Areas of thickening or induration found during vaginal and cervical palpation
– Palpable nodules
– Discrete areas of varied colors or textures
– Atypical colposcopic findings
• Colposcopy
– If abnormal findings on Pap smear
• Iodine staining of **bleep** and cervix
– To confirm boundaries of epithelial changes
– Use Lugol’s solution (half strength)
• Frequency of follow-up visits
– At least annual exams unless more frequent exams are needed
– Focus on changes since initial evaluation — include: palpation, inspection, cervical & vaginal cytology
– Colposcopy, iodine staining, biopsy as needed
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