DES Info: DES Daughters need annual specialized annual exams… (Diethylstilbestrol)

[KarenF115422]

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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