Colposcopic aspects of management of vaginal adenosis in DES children
Scott, J.W.; Seckinger, D.; Puente-Duany, W.
Journal of Reproductive Medicine 12(5): 187-193
1974
ISSN/ISBN: 0024-7758 PMID: 4838312 Document Number: 70454
This report presents evidence from clinical experience of the etiological role of in utero exposure to diethylstilbestrol (DES) in vaginal adenosis of children and adolescents. Figures depict the histological pattern of adenosis lesions, and a brief history of research and serendipity leading to the causal hypothesis is reviewed. This research included 2 retrospective studies of pediatric vaginal carcinoma (circa 1927 and 1963) as well as current studies. The study summarized here was prompted by the author's extensive use of DES for high-risk pregnancy management and his resultant attempt to locate patients exposed in utero during his practice. Office records since 1948 were reviewed, comprising 10,051 charts. Using colposcopy, 20 respondents to a questionnaire have been examined, and 17 had varying degrees of vaginal or cervical abnormalities. The mothers of all cases with severe adenosis (n=9) received more than 100 mg daily during the first trimester of pregnancy. All 20 mothers had received from 15-600 mg daily. In the 3 patients without adenosis, 1 mother was treated daily with 15 mg, starting Day 78; the second was treated with 15-25 mg daily, starting on Day 28; and the third was treated with 100 mg daily for only 5 days on Day 67-72 of gestation. 2 case reports are published. The treatment method recommended is to remove all abnormal epithelium from the top of the vagina under colposcopic guidance in the operating room under general anesthesia or in the office with local anesthesia; a small Eppendorfer biopsy instrument should be used to "weed the garden."