Diethylstilbestrol (DES) Update: Recommendations for the Identification and Management of DES-Exposed Individuals

Barbara Hammes, CNM, MS, Cynthia J. Laitman, PhD

Disclosures

J Midwifery Womens Health. 2003;48(1) 

In This Article

Effects of DES on Sons Exposed in Utero

It is important for women's health practitioners to be aware of the possible health effects DES has had on sons exposed in utero. Women are often the health care facilitators for their families. Therefore, women can be a conduit to their DES-exposed spouses and brothers. Fewer studies related to health risks have been conducted on DES sons than on DES daughters, and results have been mixed. Increased risk of benign epididymal cysts has been documented consistently in DES-exposed men.[5,6,38,41] Increased risks of other genital anatomic abnormalities (testicular hypoplasia, cryptorchidism, hypospadias, microphallus) have been associated with DES exposure in males in a smaller number of studies.[42,43] Other studies have not identified an increased risk of genital abnormalities among DES-exposed men compared with non-exposed men.[44,45]

An increased risk of testicular cancer in sons exposed to DES has not been ruled out or confirmed.[46,47,48] Depue et al. conducted a case control study of 108 cases of testicular cancer in men under 30 years old and found a relative risk of 8.0 for testicular cancer in DES sons compared with men who were not exposed to DES in utero.[49] An unpublished study by Sant et al. in 1985 found 3 of 11 DES-exposed sons with rete testis cancer, noteworthy because this type of cancer is exceedingly rare in the general population, typically occurring in men over age 50.[50] (The rete testis is a discrete cell structure within the testicle.) The most definitive clinical evidence of the association between in utero exposure to DES and testicular cancer was found in a prospective study of 3,613 men including four different DES cohorts. These investigators found elevated levels of testicular cancer among men exposed to DES in utero compared with men enrolled in the study who were not exposed to DES in utero (RR 3.05; 95% CI 0.65-22.0), a finding that was slightly more than in population-based rates.(RR 2.04; 95% CI 0.82-4.20).[11] However, the increases were not statistically significant. The investigators concluded "it is highly unlikely that DES exposure plays a major role in the increases in testicular cancer rates that have been observed in developed countries over the past 60 years." Nonetheless, they conclude that the findings of the study did "lend support to the hypothesis that the prenatal hormonal environment may influence the development of testicular cancer in adults." Because some studies show that DES-exposed men have an increased prevalence of undescended and hypoplastic testicles, it is important for health care providers to remember that these conditions of themselves are secondary risks for testicular cancer.

Although some studies show that about 30% of DES-exposed men are somehow affected by the exposure to DES, their overall ability to father children appears to remain unaffected. A 1995 study indicates no differences in fertility or sexual function between DES-exposed and non-exposed men, although three times as many DES sons reported urogenital abnormalities as men not exposed to DES.[6]

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