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    Posted January 1, 2014 by
    Dallas, Texas

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    Annual Exam for DES Daughters Recommended by the CDC

    Information to bring to your doctor!

    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 vagina and cervix.
    • Clinical breast exam
    • Vulvar inspection
    • Vaginal and cervical inspection
    – Inspection of epithelial surfaces of vagina
    – Rotation of speculum to view anterior & posterior walls of vagina
    • Cytology
    – Separate specimens from vagina fornices and cervix — all specimens placed on one slide or in liquid media
    • Palpation of vagina and cervix (an essential part of the exam)
    – Palpate entire length of vagina, including fornices
    – Note ridges or structural changes
    • Bimanual rectal-vaginal exam
    • Biopsy
    – 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 vagina and cervix
    – To confirm boundaries of epithelial changes
    – Use Lugol’s solution (half strength)
    • Frequency of follow-up visits
    – Determine on individual basis
    – Focus on changes since initial evaluation — include: palpation, inspection, cervical & vaginal cytology
    – Colposcopy, iodine staining, biopsy as needed
    – Ask about interval bleeding or abnormal vaginal discharge

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